Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Policlinico di Milano, Milano, Italy.
Department of Biomedical and Clinical Sciences "L. Sacco", Division of Medicine and Pathophysiology, Università degli Studi di Milano, Ospedale Luigi Sacco, Milano, Italy.
PLoS One. 2014 Apr 24;9(4):e96349. doi: 10.1371/journal.pone.0096349. eCollection 2014.
A high prevalence of obstructive sleep apnea syndrome (OSAS) has been reported in severely obese patients with nonalcoholic fatty liver disease (NAFLD), but few studies have evaluated OSAS in non-morbidly obese NAFLD patients.
To determine the prevalence of risk for OSAS with or without daytime sleepiness in non-morbidly obese patients with NAFLD and evaluate the association with the severity of liver damage.
We considered 159 consecutive patients with histological NAFLD and body mass index (BMI) <35 Kg/m2, and 80 controls without ultrasonographic steatosis matched for age, sex, and BMI. OSAS risk was determined by positivity for Berlin questionnaire (BQ), and daytime sleepiness by the Sleepness Epworth Scale (ESS). Liver damage was evaluated according to the NAFLD activity score.
In NAFLD patients, BQ alone was positive in 39 (25%), ESS in 8 (5%), and both in 13 (8%, OSAS with sleepines); p = ns vs. controls without steatosis. In NAFLD patients at risk for OSAS with (but not in those without) sleepiness, we observed a higher prevalence of nonalcoholic steatohepatitis (NASH; 11/13, 85% vs. 72/146, 49%; p = 0.018), and of clinically significant fibrosis (stage>1; 9/13, 69% vs. 39/146, 27%; p = 0.003). At multivariate logistic regression analysis, OSAS with sleepiness was strongly associated with NASH and fibrosis>1 independently of known clinical risk factors such as age, gender, BMI, diabetes, and ALT levels (OR 7.1, 95% c.i. 1.7-51, p = 0.005 and OR 14.0, 95% c.i. 3.5-70, p = 0.0002, respectively).
A proportion of NAFLD patients without severe obesity is at risk for OSAS with daytime sleepiness, which is associated with the severity of liver damage independently of body mass and other cofactors.
非酒精性脂肪性肝病（NAFLD）患者中重度肥胖者阻塞性睡眠呼吸暂停综合征（OSAS）的患病率较高，但很少有研究评估非病态肥胖的 NAFLD 患者的 OSAS。
确定非病态肥胖的 NAFLD 患者发生 OSAS 的风险，包括有或无日间嗜睡，并评估其与肝损伤严重程度的关系。
我们考虑了 159 例连续的组织学 NAFLD 患者和 BMI<35kg/m2，以及 80 例超声无脂肪变性且年龄、性别和 BMI 匹配的对照组。OSAS 风险通过柏林问卷（BQ）确定，日间嗜睡通过嗜睡 Epworth 量表（ESS）确定。根据 NAFLD 活动评分评估肝损伤。
在 NAFLD 患者中，BQ 单独阳性者 39 例（25%），ESS 阳性者 8 例（5%），两者均阳性者 13 例（8%，伴有嗜睡的 OSAS）；与无脂肪变性的对照组相比，差异无统计学意义（p=ns）。在伴有（但不伴有）嗜睡的 OSAS 风险的 NAFLD 患者中，我们观察到非酒精性脂肪性肝炎（NASH；11/13，85% vs. 72/146，49%；p=0.018）和临床显著纤维化（分期>1；9/13，69% vs. 39/146，27%；p=0.003）的患病率更高。多变量逻辑回归分析显示，伴有嗜睡的 OSAS 与 NASH 和纤维化>1 独立于年龄、性别、BMI、糖尿病和 ALT 水平等已知临床危险因素密切相关（OR 7.1，95%可信区间 1.7-51，p=0.005 和 OR 14.0，95%可信区间 3.5-70，p=0.0002）。
一部分非病态肥胖的 NAFLD 患者存在日间嗜睡的 OSAS 风险，且该风险与肝损伤的严重程度相关，与体重指数和其他因素无关。
