Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China.
Hepatol Int. 2022 Aug;16(4):824-834. doi: 10.1007/s12072-022-10347-2. Epub 2022 Jun 6.
The association between the severity of obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD) in patients with obesity remains unclear. We conducted this study to determine the effects of OSA on the severity of NAFLD in individuals with obesity and its link to the development of non-alcoholic steatohepatitis (NASH).
Patients were subjected to standard polysomnography up to 1 week before undergoing bariatric surgery, during which liver biopsy specimens were obtained. The apnea-hypopnea index (AHI) obtained by polysomnography was used to determine the severity of OSA.
In total, 183 patients with obesity and biopsy-confirmed NAFLD were included; 49 (27%) had NASH. Patients with NASH had higher AHIs (p = 0.014) and oxygen desaturation indices (p = 0.031), more frequent OSA (p = 0.001), and lower minimum oxygen saturation (p = 0.035). The severity of OSA was directly correlated with the NAFLD activity score (p < 0.001), NASH activity grade (p < 0.001), semi-quantitative indices of lobular inflammation (p = 0.001), and hepatocyte ballooning (p = 0.006). The odds ratios (95% confidence intervals) for NASH and severe NASH (activity grade ≥ 3) associated with moderate-to-severe OSA were 3.85 (1.35-10.94; p < 0.05) and 5.02 (1.66-15.18; p < 0.01), respectively, after adjusting for sex, age, body mass index, waist circumference, insulin resistance values, and metabolic syndrome.
Chronic intermittent hypoxia caused by OSA may aggravate NAFLD and lead to a higher risk of NASH in patients with obesity.
肥胖患者阻塞性睡眠呼吸暂停（OSA）严重程度与非酒精性脂肪性肝病（NAFLD）之间的关系尚不清楚。本研究旨在确定 OSA 对肥胖个体中 NAFLD 严重程度的影响及其与非酒精性脂肪性肝炎（NASH）发展的关系。
患者在接受减重手术前 1 周内接受标准多导睡眠图检查，在此期间获取肝活检标本。多导睡眠图获得的呼吸暂停低通气指数（AHI）用于确定 OSA 的严重程度。
共纳入 183 例肥胖且经肝活检证实为 NAFLD 的患者；其中 49 例（27%）患有 NASH。患有 NASH 的患者 AHI 更高（p=0.014）和氧减指数（p=0.031），更频繁地发生 OSA（p=0.001），且最低氧饱和度更低（p=0.035）。OSA 的严重程度与 NAFLD 活动评分（p<0.001）、NASH 活动分级（p<0.001）、小叶炎症的半定量指标（p=0.001）和肝细胞气球样变（p=0.006）呈直接相关。中重度 OSA 与 NASH 和重度 NASH（活动分级≥3）相关的比值比（95%置信区间）分别为 3.85（1.35-10.94；p<0.05）和 5.02（1.66-15.18；p<0.01），在调整性别、年龄、体重指数、腰围、胰岛素抵抗值和代谢综合征后。
OSA 引起的慢性间歇性缺氧可能加重 NAFLD，并使肥胖患者发生 NASH 的风险增加。
