Department of Internal Medicine II, University Hospital Regensburg, Germany.
Department of Pneumology, Clinic Donaustauf, Germany.
Sleep Med. 2023 Dec;112:159-164. doi: 10.1016/j.sleep.2023.10.018. Epub 2023 Oct 17.
Sleep-disordered breathing (SDB) and non-alcoholic fatty liver disease (NAFLD) are both common comorbidities in obese patients. Structured weight loss programs are effective and can reduce the incidence and severity of obesity-related comorbidities. The objective of the present analysis is to test whether weight loss induced alleviation of SDB is a predictor for improvement of NAFLD.
Obese participants underwent a standardized non-surgical 3 months weight reduction program (800 kilocalories per day with low carbohydrate and fat content). Abdominal sonography for NAFLD (grade 0 to 3) and monitoring for SDB (defined as apnea-hypopnea index [AHI] ≥ 15/h) were performed at baseline and after 3 months. Alleviation of SDB was defined as a shift from AHI≥ 15/h to <15/h.
48 patients (48% female, age 42 ± 12 years, body-mass index 40.3 ± 8.1 kg/m, AHI 14 ± 17/h, 85% NAFLD grade ≥1) participated in the weight loss program. In contrast to the no SDB group, in patients with SDB weight loss of 27.1 ±0 .9 kg (8.4 ± 2.8 kg/m) after three months was paralleled by a reduction in AHI (-22 ± 17/h), prevalence of SDB (from 31% to 13%), and oxidized low-density lipoprotein (-13 ± 11 U/l). In individuals with preexisting SDB NAFLD grade improved more (2 versus 1, p<0.001) and was at a lower degree at 3 months than in those without SDB (0 versus 1, p = 0.015). In multivariable analysis models, SDB at baseline was associated with improvement of NAFLD grade (B 0.908; 95% CI 0.125, 1.691; p = 0.024), independently of age, sex, and BMI (each p>0.05, respectively). Decreasing BMI (B 0.16 [95%-CI 0.08; 0.23], p<0.001) and alleviation of SDB (B 0.90 [95%-CI 0.21; 1.58], p = 0.012) were independently associated with improvement of NAFLD grade.
Preexisting SDB and weight loss induced alleviation of SDB are predictors for improvement in NAFLD grade, independent of the extent of weight loss. SDB may contribute to the pathogenesis of NAFLD via SDB-induced oxidative stress and inflammation, but the causal mechanism remains unclear.
睡眠呼吸紊乱（SDB）和非酒精性脂肪肝疾病（NAFLD）都是肥胖患者常见的合并症。结构化的减肥计划是有效的，可以降低肥胖相关合并症的发生率和严重程度。本分析的目的是测试减肥引起的 SDB 缓解是否是改善 NAFLD 的预测因素。
肥胖参与者接受了为期 3 个月的标准化非手术减肥计划（每天 800 卡路里，碳水化合物和脂肪含量低）。在基线和 3 个月后进行腹部超声检查以评估 NAFLD（0 至 3 级）和监测 SDB（定义为呼吸暂停低通气指数[AHI]≥15/h）。SDB 的缓解定义为从 AHI≥15/h 转为<15/h。
48 名患者（48%为女性，年龄 42±12 岁，体重指数 40.3±8.1kg/m，AHI 14±17/h，85%的 NAFLD 分级≥1）参加了减肥计划。与无 SDB 组相比，在有 SDB 的患者中，3 个月后体重减轻 27.1±0.9kg（8.4±2.8kg/m），同时 AHI 降低（-22±17/h）、SDB 患病率（从 31%降至 13%）和氧化型低密度脂蛋白（-13±11 U/l）。在存在 SDB 的个体中，NAFLD 分级改善更明显（2 级与 1 级相比，p<0.001），且在 3 个月时的程度低于无 SDB 的个体（0 级与 1 级相比，p=0.015）。在多变量分析模型中，基线 SDB 与 NAFLD 分级的改善相关（B 0.908；95%CI 0.125，1.691；p=0.024），独立于年龄、性别和 BMI（分别为 p>0.05）。BMI 降低（B 0.16[95%-CI 0.08；0.23]，p<0.001）和 SDB 缓解（B 0.90[95%-CI 0.21；1.58]，p=0.012）与 NAFLD 分级的改善独立相关。
存在 SDB 和减肥引起的 SDB 缓解是改善 NAFLD 分级的预测因素，与减肥的程度无关。SDB 通过 SDB 诱导的氧化应激和炎症可能导致 NAFLD 的发病机制，但因果机制尚不清楚。
