Yu Tianqi, Zhou Yongxu, Wu Xu, Fang Zhihao, Liu Chang
Department of General Surgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China.
Nat Sci Sleep. 2025 Jun 17;17:1361-1376. doi: 10.2147/NSS.S524675. eCollection 2025.
Obstructive sleep apnea (OSA) is a common condition that is linked to various complications. Despite its prevalence, limited research has explored the association between OSA and non-alcoholic fatty liver disease (NAFLD). The aim of this study was to examine whether individuals at risk for OSA are more likely to develop NAFLD.
This study employed a cross-sectional design coupled with Mendelian randomization, using data from the National Health and Nutrition Examination Survey (NHANES) collected between 2017 and 2020. A total of 6215 eligible participants were included. Multivariable logistic regression was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the relationship between OSA and NAFLD, adjusting for age, sex, ethnicity, education level, body mass index (BMI), diabetes, and hypertension. To assess causal inference and minimize observational bias, five distinct two-sample Mendelian randomization approaches were applied.
After excluding 9345 individuals who did not meet the study criteria, a total of 6215 participants were included. The weighted prevalence of OSA and NAFLD in the cohort was 43.1% and 43.0%, respectively. Compared with individuals without NAFLD, those with NAFLD were older (median age 52.0 vs 44.0 years), and exhibited higher levels of HbA1c (5.70% vs 5.40%), fasting glucose, total cholesterol, triglycerides, and liver enzymes such as ALT. Additionally, NAFLD patients had markedly higher rates of comorbid conditions including hypertension (65% vs 40%), diabetes (29% vs 14%), and OSA (51% vs 36%). After adjusting for potential confounders, multivariable logistic regression demonstrated a significant association between OSA and NAFLD (OR = 1.86, 95% CI: 1.63-2.11, p < 0.001). Mendelian randomization analysis further suggested a potential causal effect of genetically predicted OSA on NAFLD risk (IVW OR = 1.066, 95% CI: 1.010-1.125, p = 0.020).
These findings suggest a potential association between OSA and the development of NAFLD. While the results provide preliminary evidence for a link, further longitudinal and interventional studies are needed to clarify causality and inform clinical practice.
阻塞性睡眠呼吸暂停（OSA）是一种常见病症，与多种并发症相关。尽管其发病率高，但关于OSA与非酒精性脂肪性肝病（NAFLD）之间关联的研究有限。本研究的目的是检验有OSA风险的个体是否更易患NAFLD。
本研究采用横断面设计并结合孟德尔随机化方法，使用2017年至2020年期间收集的美国国家健康与营养检查调查（NHANES）数据。共纳入6215名符合条件的参与者。进行多变量逻辑回归以估计OSA与NAFLD之间关系的比值比（OR）和95%置信区间（CI），并对年龄、性别、种族、教育水平、体重指数（BMI）、糖尿病和高血压进行校正。为评估因果推断并最小化观察性偏倚，应用了五种不同的两样本孟德尔随机化方法。
排除9345名不符合研究标准的个体后，共纳入6215名参与者。队列中OSA和NAFLD的加权患病率分别为43.1%和43.0%。与无NAFLD的个体相比，患有NAFLD的个体年龄更大（中位年龄52.0岁对44.0岁），且糖化血红蛋白（HbA1c）、空腹血糖、总胆固醇、甘油三酯以及谷丙转氨酶（ALT）等肝酶水平更高。此外，NAFLD患者合并症的发生率明显更高，包括高血压（65%对40%）、糖尿病（29%对14%）和OSA（51%对36%）。在对潜在混杂因素进行校正后，多变量逻辑回归显示OSA与NAFLD之间存在显著关联（OR = 1.86，95%CI：1.63 - 2.11，p < 0.001）。孟德尔随机化分析进一步表明，基因预测的OSA对NAFLD风险具有潜在因果效应（逆方差加权法OR = 1.066，95%CI：1.010 - 1.125，p = 0.020）。
这些发现提示OSA与NAFLD的发生之间可能存在关联。虽然结果为两者之间的联系提供了初步证据，但仍需要进一步的纵向研究和干预性研究来阐明因果关系并为临床实践提供依据。
