Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China.
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Pediatr Obes. 2021 Mar;16(3):e12718. doi: 10.1111/ijpo.12718. Epub 2020 Sep 2.
Some studies have reported a relationship between obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD) in pediatric population. However, this issue remains controversial.
The purpose of the present study was to investigate the association between OSA and NAFLD in pediatric population.
We systematically searched PubMed, Web of Science, Embase for eligible studies. The data involving markers of NAFLD including alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatic inflammation, hepatic fibrosis of both OSA group and control group were extracted. Pooled standardised mean difference (SMD) and weighted mean difference (WMD) were appropriately calculated through a fixed or random-effect model.
Nine cross-sectional studies with 1133 children and adolescents were included. OSA was significantly associated with ALT, AST, and NAFLD fibrosis stage, but not NAFLD inflammation grade. Subgroup analysis indicated that both mild OSA and severe OSA were significantly associated with elevated ALT and AST. Furthermore, in the studies with all main confounding factors (age, gender, and BMI) matched, OSA group had higher ALT and AST levels than control group.
This meta-analysis suggested that OSA was associated with NAFLD evidenced by elevated liver enzymes and progressive hepatic fibrosis in pediatric population. Screening and monitoring of NAFLD in pediatric patients with obesity-related OSA are necessary.
一些研究报告称，阻塞性睡眠呼吸暂停（OSA）与儿童人群中的非酒精性脂肪性肝病（NAFLD）之间存在关系。然而，这一问题仍存在争议。
本研究旨在探讨儿童人群中 OSA 与 NAFLD 之间的关联。
我们系统地检索了 PubMed、Web of Science 和 Embase 中的合格研究。提取了涉及 OSA 组和对照组的 NAFLD 标志物（包括丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、肝炎症和肝纤维化）的数据。通过固定或随机效应模型适当计算了标准化均数差（SMD）和加权均数差（WMD）。
纳入了 9 项横断面研究，涉及 1133 名儿童和青少年。OSA 与 ALT、AST 和 NAFLD 纤维化分期显著相关，但与 NAFLD 炎症分级无关。亚组分析表明，轻度 OSA 和重度 OSA 均与 ALT 和 AST 升高显著相关。此外，在所有主要混杂因素（年龄、性别和 BMI）匹配的研究中，OSA 组的 ALT 和 AST 水平高于对照组。
本荟萃分析表明，OSA 与儿童人群中的 NAFLD 相关，表现为肝酶升高和进行性肝纤维化。肥胖相关 OSA 的儿科患者需要筛查和监测 NAFLD。
