Risk Factors of Nonalcoholic Fatty Liver Disease and Liver Fibrosis in Non-Obese Patients with Obstructive Sleep Apnea

Sleep behaviors and metabolic-associated fatty liver disease

OBJECTIVE

This study aimed to comprehensively evaluate the association between various sleep behaviors and the risk of metabolic-associated fatty liver disease (MAFLD), particularly self-reported snoring.

METHODS

Multivariate logistic regression was used to explore independent factors associated with MAFLD. ROC curve and decision curve analyses were used to analyze and compare the different indicators.

RESULTS

A total of 3708 patients were enrolled, and 41.4% of them had MAFLD. According per multivariate logistic regression analysis, self-reported snoring was an independent predictor of MAFLD (p < 0.001), particularly the occasional and frequent snoring groups [OR (95% CI): 1.44 (1.12-1.87), 1.48 (1.15-1.91), p < 0.001]. In addition, the liver function levels and incidence rates of metabolic parameters were independently associated with the severity of self-reported snoring (all p < 0.05). Subgroup analyses suggested that the frequency of snoring was independently related to the risk of MAFLD in young and middle-aged patients (both p < 0.05), and was no longer associated with any frequency of self-reported snoring in the subgroup older than 60 years (p = 0.400). In both female and male subgroup, subjects who snored frequently had a higher odds risk of MAFLD than those who did not (both p < 0.05). The area under the ROC curve for snoring was 0.638, which was superior to that of the other indicators for MAFLD prediction (all p < 0.001). Meanwhile, decision curve analysis showed that snoring had a better clinical net benefit compared to other biomarkers, with a threshold probability (Pt) of approximately 0.3-0.6.

CONCLUSION

Self-reported snoring was an independent risk factor for MAFLD in young and middle-aged subjects with a moderate predictive value. Therefore, intense monitoring and evaluation of MAFLD in these patients is necessary.

Exploring the Impact of Obstructive Sleep Apnea on Cirrhosis: A Comprehensive Review

This paper assesses the existing literature to explore the association between obstructive sleep apnea (OSA) and cirrhosis. While OSA's impact on metabolic dysfunction-associated steatotic liver disease (MASLD) is well-established, limited data exists for other causes of chronic liver disease. The review examines OSA's role in cirrhosis, emphasizing its potential influence on liver disease progression and laying the groundwork for future studies. Current data indicates a greater likelihood of liver disease in individuals with OSA, with continuous positive airway pressure (CPAP) treatment potentially slowing liver disease advancement. Undiagnosed OSA exacerbates liver disease progression, underscoring the urgency of identifying and managing sleep disturbances in patients with liver disease. Patients with a BMI over 30 and liver disease should be screened for sleep disturbances. Addressing sleep issues and OSA could enhance well-being and liver disease management in these patients.

A mendelian randomization study investigating the association between sleep apnea risk and cheese consumption through biomarker analysis

Cheese consumption may play a role in mitigating sleep apnea risk, according to our Mendelian randomization (MR) study. Sleep apnea, a prevalent disorder associated with various health complications, affects millions worldwide, generating interest in dietary interventions. This study analyzed data from the UK Biobank and the FinnGen Biobank, focusing on cheese intake and its potential impact on sleep apnea through various biomarkers. Results revealed a significant inverse association between cheese consumption and sleep apnea risk (OR=0.724, p=0.00478), indicating that higher cheese intake is linked to a reduced likelihood of developing the disorder. Additionally, the analysis identified six biomarkers, including aspartate aminotransferase (1.33 %), urea (3.85 %), cystatin C (2.98 %), sex hormone-binding globulin (1.78 %), testosterone (1.94 %), and diastolic blood pressure (5.46 %), as mediators of this relationship. Notably, cheese consumption influenced levels of 23 biomarkers. These findings underscore the potential of dietary interventions in public health strategies aimed at decreasing sleep apnea prevalence and associated health risks. Overall, this study highlights the complex connections between diet, biomarkers, and sleep apnea, emphasizing the necessity for further research across diverse populations to enhance the generalizability of these results.

Association between sleep apnea and ultrasound-defined liver fibrosis: Results from NHANES 2017 to 2020

Liver fibrosis is a critical factor in the advancement of nonalcoholic fatty liver disease towards cirrhosis. There is limited research exploring the association between obstructive sleep apnea (OSA) and liver fibrosis among community populations. The present study aimed to assess the association between sleep apnea (SA) and liver fibrosis based on the National Health and Nutrition Examination Survey (NHANES). Data were acquired from NHANES survey cycle 2017 to 2020. We assessed liver fibrosis by the median values of liver stiffness measurement (LSM). The diagnosis of SA was based on participants' response to sleep questionnaire. Univariate and multivariate logistic regression were used to validate the association of SA and liver fibrosis. A total of 7615 participants were included in this study. The LSM level of SA group was significantly higher than non-SA group. The proportion of liver fibrosis in SA group was markedly higher than that in non-SA group (14.0% vs 7.3%, P < .001). Univariate logistic analysis showed that SA was positively associated with liver fibrosis (OR = 2.068, 95%CI = 1.715-2.494, P < .001). Further multivariate logistic analysis revealed that SA was independently associated with increased risk of liver fibrosis after adjusting for confounding factors (OR = 1.277, 95%CI = 1.003-1.625, P = .048). The current study demonstrated an independent association between self-reported SA and increased risk of ultrasound-defined liver fibrosis in community-based sample.

Non-alcoholic fatty liver disease and sleep disorders

Studies have shown that non-alcoholic fatty liver disease (NAFLD) may be associated with sleep disorders. In order to explore the explicit relationship between the two, we systematically reviewed the effects of sleep disorders, especially obstructive sleep apnea (OSA), on the incidence of NAFLD, and analyzed the possible mechanisms after adjusting for confounding factors. NAFLD is independently associated with sleep disorders. Different sleep disorders may be the cause of the onset and aggravation of NAFLD. An excessive or insufficient sleep duration, poor sleep quality, insomnia, sleep-wake disorders, and OSA may increase the incidence of NAFLD. Despite that some research suggests a unidirectional causal link between the two, specifically, the onset of NAFLD is identified as a result of changes in sleep characteristics, and the reverse relationship does not hold true. Nevertheless, there is still a lack of specific research elucidating the reasons behind the higher risk of developing sleep disorders in individuals with NAFLD. Further research is needed to establish a clear relationship between NAFLD and sleep disorders. This will lay the groundwork for earlier identification of potential patients, which is crucial for earlier monitoring, diagnosis, effective prevention, and treatment of NAFLD.