Department of Medicine, University of Vermont, Burlington, Vermont.
Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e308-e312. doi: 10.1097/MEG.0000000000002049.
Patients with nonalcoholic fatty liver disease (NAFLD) have sleep disruption. The aim of this study is to understand how underlying factors such as diet, degree of liver disease and morningness-eveningness tendencies contribute to this sleep disruption.
Patients with NAFLD were recruited from liver clinics at a University and Veterans Affairs practice. Patients with decompensated cirrhosis were excluded. Patients completed self-reported surveys to evaluate sleep disturbance using the Epworth Sleepiness Scale (ESS) and chronotype (circadian preference) using the morningness-eveningness questionnaire (MEQ). Information on occupation, physical activity and dietary intake were collected at clinic intake. Dietary intake was evaluated via food-frequency questionnaire and analyzed as individual categories or grouped on the basis of dietary composition.
A 54 patients completed the survey; 37% were female. Median ESS was 8 ± 4.2 and 37% of NAFLD patients were found to have sleep disturbance as defined by ESS >10. Sleep disturbance was common in NAFLD regardless of the liver disease stage. Dietary factors, including higher added sugar (P = 0.01), candy intake (P = 0.01), elevated Ferritin level (P = 0.04) and elevated platelet count (P = 0.05), were significantly associated with sleep disturbance. Chronotype, time to sleep, and duration of sleep were not associated with sleep disruption.
Sleep disruption is present in NAFLD regardless of underlying cirrhosis. Interventions aimed at improving dietary and lifestyle practices such as reduced sugar intake may help mitigate the risk for sleep disruption in NAFLD. Further longitudinal studies are needed to further delineate these links.
非酒精性脂肪性肝病 (NAFLD) 患者存在睡眠障碍。本研究旨在了解饮食、肝病严重程度和早晚倾向等潜在因素如何导致这种睡眠障碍。
从大学和退伍军人事务处的肝脏诊所招募了 NAFLD 患者。排除失代偿性肝硬化患者。患者完成了自我报告的调查，使用 Epworth 嗜睡量表 (ESS) 评估睡眠障碍，使用早晚倾向问卷 (MEQ) 评估昼夜节律偏好（即生物钟）。在诊所就诊时收集职业、体力活动和饮食摄入信息。通过食物频率问卷评估饮食摄入，并根据饮食成分进行单独分类或分组分析。
共有 54 名患者完成了调查；37%为女性。ESS 的中位数为 8 ± 4.2，37%的 NAFLD 患者的 ESS>10，表明存在睡眠障碍。无论肝病阶段如何，NAFLD 患者的睡眠障碍都很常见。饮食因素，包括较高的添加糖（P=0.01）、糖果摄入量（P=0.01）、铁蛋白水平升高（P=0.04）和血小板计数升高（P=0.05），与睡眠障碍显著相关。昼夜节律、入睡时间和睡眠时间与睡眠障碍无关。
无论潜在的肝硬化情况如何，NAFLD 患者都存在睡眠障碍。旨在改善饮食和生活方式的干预措施，如减少糖的摄入，可能有助于降低 NAFLD 患者发生睡眠障碍的风险。需要进一步的纵向研究来进一步阐明这些联系。
