Cao Junyan, Qiu Weihong, Lin Yuwei, Liu Tianyu, Dou Zulin, Chen Zhaocong
Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, China.
Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, China.
Prev Med Rep. 2023 Sep 9;36:102406. doi: 10.1016/j.pmedr.2023.102406. eCollection 2023 Dec.
Steatosis is the hepatic manifestation of metabolic syndrome (MetS) and its developing is closely associated with insulin resistance. Shortened sleep has adverse effects on hepatic steatosis and the underlying mechanism remains unknown. We conceived to evaluate whether sleep duration was a lifestyle factor modifying the association between insulin resistance and hepatic steatosis and whether it was varied in different status of metabolic disturbances. We performed a cross-sectional analysis on 2264 adults of United States representing a population of 138,319,512 with MetS or pre-MetS from National Health and Nutrition Examination Survey (NHANES) 2017-March 2020. Participants underwent hepatic transient elastography and laboratory tests. The sleep duration was obtained from interviews. Results showed that insulin resistance was significantly associated with hepatic steatosis among participants with metabolic disturbances (OR = 1.85, 95% CI: 1.30-2.65). Significant moderation of sleep duration on the association between insulin resistance and hepatic steatosis was observed when sleep duration was dichotomized by 6.5- (P = 0.042) or 9.5-hour (P = 0.031). The risk of hepatic steatosis associated with insulin resistance was increased when sleep duration was ≤ 6.5 h and > 9.5 h. Furthermore, the moderation effect of 6.5-hour sleeping was only significant among participants with pre-MetS while that of 9.5-hour sleeping was only significant among participants with MetS. In conclusion, insufficient or excessive sleep increased the risk of hepatic steatosis associated with insulin resistance. Appropriate sleep duration was advocated and varied in different status of metabolic disturbances. Ensuring adequate sleep should be highlighted before MetS occurs and excessive sleep should be prevented for participants with MetS.
肝脂肪变性是代谢综合征（MetS）的肝脏表现，其发展与胰岛素抵抗密切相关。睡眠不足对肝脂肪变性有不良影响，但其潜在机制尚不清楚。我们旨在评估睡眠时间是否是一个影响胰岛素抵抗与肝脂肪变性之间关联的生活方式因素，以及它在不同代谢紊乱状态下是否有所不同。我们对来自2017年美国国家健康与营养检查调查（NHANES）至2020年3月的2264名成年人进行了横断面分析，这些成年人代表了138,319,512名患有MetS或MetS前期的人群。参与者接受了肝脏瞬时弹性成像检查和实验室检测。睡眠时间通过访谈获得。结果显示，在患有代谢紊乱的参与者中，胰岛素抵抗与肝脂肪变性显著相关（OR = 1.85，95% CI：1.30 - 2.65）。当睡眠时间以6.5小时（P = 0.042）或9.5小时（P = 0.031）进行二分法划分时，观察到睡眠时间对胰岛素抵抗与肝脂肪变性之间的关联有显著的调节作用。当睡眠时间≤6.5小时和>9.5小时时，与胰岛素抵抗相关的肝脂肪变性风险增加。此外，6.5小时睡眠的调节作用仅在患有MetS前期的参与者中显著，而9.5小时睡眠的调节作用仅在患有MetS的参与者中显著。总之，睡眠不足或过长会增加与胰岛素抵抗相关的肝脂肪变性风险。提倡适当的睡眠时间，并根据不同的代谢紊乱状态而有所不同。在MetS发生前应强调确保充足睡眠，对于患有MetS的参与者应防止睡眠过长。
