Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University Sejong Hospital, Chungnam National University, Sejong, Korea.
PLoS One. 2022 Jul 20;17(7):e0271021. doi: 10.1371/journal.pone.0271021. eCollection 2022.
BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is one of the most common health problems worldwide. Sleep apnea (SA) causes cardiovascular and metabolic problems, as well as a significant socioeconomic burden. Although several studies have found that SA causes NAFLD, there is no evidence that NAFLD causes SA. The goal of this study was to look at the relationship between NAFLD and SA in realworld data.
We evaluated 334,334 healthy individuals without comorbidities who underwent National Health checkups in the Republic of Korea from 2009 to 2014. NAFLD was defined by a surrogate marker, the fatty liver index (FLI). The association between FLI and SA was analyzed using multivariate Cox proportional hazards regression models.
During a median followup of 5.3 years, 1,351 patients (0.4%) were newly diagnosed with SA. Subjects were categorized into quartile groups according to FLI (range: Q1, 0-4.9; Q2, 5.0-12.5; Q3, 12.6-31.0; Q4, >31.0). Subjects with higher FLIs had a significantly higher cumulative incidence of SA than those with lower FLIs (Q1, 119 [0.1%]; Q2, 210 [0.3%]; Q3, 339 [0.4%]; Q4, 683 [0.8%]; P < 0.001). Adjusted hazard ratios (HRs) revealed that a higher FLI was independently associated with an increased risk of SA (HR between Q4 and Q1, 4.03; 95% confidence interval, 3.22-5.05; P < 0.001). This association remained statistically significant after further adjustment for Body mass index (BMI) (HR between Q4 and Q1, 2.19; 95% confidence interval, 1.69-2.83; P < 0.001). FLI was significantly associated with an increased risk of new-onset SA regardless of baseline characteristics.
This study demonstrated that NAFLD, assessed by FLI, was independently associated with increased risk for SA in the healthy Korean population.
非酒精性脂肪性肝病（NAFLD）是全球最常见的健康问题之一。睡眠呼吸暂停（SA）会导致心血管和代谢问题，以及显著的社会经济负担。尽管有几项研究发现 SA 会导致 NAFLD，但没有证据表明 NAFLD 会导致 SA。本研究旨在观察真实世界数据中 NAFLD 与 SA 之间的关系。
我们评估了 2009 年至 2014 年期间在大韩民国接受国家健康检查的 334334 名无合并症的健康个体。NAFLD 由替代标志物——脂肪肝指数（FLI）定义。使用多变量 Cox 比例风险回归模型分析 FLI 与 SA 之间的关联。
在中位随访 5.3 年期间，有 1351 例（0.4%）患者新诊断为 SA。根据 FLI 将受试者分为四分位组（范围：Q1，0-4.9；Q2，5.0-12.5；Q3，12.6-31.0；Q4，>31.0）。FLI 较高的受试者发生 SA 的累积发生率明显高于 FLI 较低的受试者（Q1，119 [0.1%]；Q2，210 [0.3%]；Q3，339 [0.4%]；Q4，683 [0.8%]；P<0.001）。调整后的危险比（HR）显示，较高的 FLI 与 SA 风险增加独立相关（Q4 与 Q1 相比，HR 为 4.03；95%置信区间，3.22-5.05；P<0.001）。进一步调整体重指数（BMI）后，这种关联仍然具有统计学意义（Q4 与 Q1 相比，HR 为 2.19；95%置信区间，1.69-2.83；P<0.001）。无论基线特征如何，FLI 均与新发 SA 的风险增加显著相关。
本研究表明，在健康的韩国人群中，通过 FLI 评估的 NAFLD 与 SA 风险增加独立相关。
