Huang Jiefeng, Chen Lida, Li Xiuling, Chen Menglan, Lin Ting, Chen Gongping
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.
Institute of Respiratory Disease, Fujian Medical University, Fujian Medical University, Fuzhou, People's Republic of China.
Nat Sci Sleep. 2023 Feb 28;15:49-57. doi: 10.2147/NSS.S398971. eCollection 2023.
Emerging evidence has revealed that obstructive sleep apnea (OSA) is an independent risk factor for the development of a variety of adverse metabolic disease states. In this study, we evaluated the association between OSA severity and metabolic dysfunction-associated fatty liver disease (MAFLD) among Asian populations.
This was a cross-sectional, single-center study. The study cohort consisted of patients undergoing polysomnography and abdominal ultrasonography. Logistic regression analysis was used to evaluate the independent risk factors of MAFLD in patients with OSA.
A total of 1065 patients (277 non-MAFLD and 788 MAFLD) were included in the study. The prevalence of MAFLD in non-OSA, mild-moderate OSA, and severe OSA patients was 58.16%, 72.41%, and 78.0%, respectively ( < 0.001). We identified significant differences in body mass index (BMI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and lowest O saturation (LaSO) between non-MAFLD and MAFLD patients (all < 0.001). After adjusting for confounding variables, we used multivariate regression analysis to show that BMI, ODI, and triglyceride (TG) levels independently predicted the occurrence of MAFLD (odds ratio [OR] = 1.234, < 0.001; OR = 1.022, = 0.013; OR = 1.384, = 0.001, respectively). Moreover, stratified analysis according to BMI indicated that TG levels were the predominant risk factor for MAFLD in a group of patients with a BMI < 23 kg/m, while BMI, ODI, TG levels, and total cholesterol (TC) were the major risk factors for MAFLD in a group of patients with a BMI ≥ 23 kg/m (all < 0.05).
OSA-associated chronic intermittent hypoxia was independently associated with the risk of MAFLD, especially in OSA patients with a BMI ≥ 23 kg/m, suggesting that oxidative stress might play an important role in the pathogenesis of MAFLD in patients with OSA.
新出现的证据表明，阻塞性睡眠呼吸暂停（OSA）是多种不良代谢疾病状态发生的独立危险因素。在本研究中，我们评估了亚洲人群中OSA严重程度与代谢功能障碍相关脂肪性肝病（MAFLD）之间的关联。
这是一项横断面单中心研究。研究队列包括接受多导睡眠图和腹部超声检查的患者。采用逻辑回归分析评估OSA患者发生MAFLD的独立危险因素。
本研究共纳入1065例患者（277例非MAFLD患者和788例MAFLD患者）。非OSA、轻中度OSA和重度OSA患者中MAFLD的患病率分别为58.16%、72.41%和78.0%（<0.001）。我们发现非MAFLD患者和MAFLD患者在体重指数（BMI）、呼吸暂停低通气指数（AHI）、氧饱和度下降指数（ODI）和最低血氧饱和度（LaSO）方面存在显著差异（均<0.001）。在调整混杂变量后，我们使用多因素回归分析表明，BMI、ODI和甘油三酯（TG）水平独立预测MAFLD的发生（优势比[OR]=1.234，<0.001；OR=1.022，=0.013；OR=1.384，=0.001）。此外，根据BMI进行分层分析表明，在BMI<23kg/m的患者组中，TG水平是MAFLD的主要危险因素，而在BMI≥23kg/m的患者组中，BMI、ODI、TG水平和总胆固醇（TC）是MAFLD的主要危险因素（均<0.05）。
OSA相关的慢性间歇性缺氧与MAFLD的风险独立相关，尤其是在BMI≥23kg/m的OSA患者中，这表明氧化应激可能在OSA患者MAFLD的发病机制中起重要作用。
