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Adeva-Andany MM, Domínguez-Montero A, Castro-Quintela E, Funcasta-Calderón R, Fernández-Fernández C. Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review. Rev Cardiovasc Med 2024; 25:231. [PMID: 39076340 PMCID: PMC11270082 DOI: 10.31083/j.rcm2506231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 07/31/2024] Open
Abstract
Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- γ ) downregulation. In human adipose tissue, PPAR- γ activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- γ in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.
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Yi M, Fei Q, Chen Z, Zhao W, Liu K, Jian S, Liu B, He M, Su X, Zhang Y. Unraveling the associations and causalities between glucose metabolism and multiple sleep traits. Front Endocrinol (Lausanne) 2023; 14:1227372. [PMID: 38027156 PMCID: PMC10660979 DOI: 10.3389/fendo.2023.1227372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The aim of our study is to estimate the associations and causalities of glucose metabolism traits of fasting blood glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin (HbA1c), and 2-h glucose post-challenge (2hGlu) with sleep traits consisting of excessive daytime sleepiness (EDS), insomnia, and sleep duration. Methods We employed standard quantitative analysis procedures to assess the associations between sleep traits and glucose metabolism. Moreover, we acquired published genome-wide association studies (GWAS) summary statistics for these traits and conducted Mendelian randomization (MR) analyses to estimate their causal directions and effects. Inverse variance weighting (IVW) was employed as the primary approach, followed by sensitivity analyses. Results A total of 116 studies with over 840,000 participants were included in the quantitative analysis. Our results revealed that participants with abnormal glucose metabolism had higher risks for EDS (OR [95% CI] = 1.37 [1.10,1.69]), insomnia (OR [95% CI] = 1.65 [1.24,2.20]), and both short and long sleep duration (OR [95% CI] = 1.35 [1.12,1.63]; OR [95% CI] = 1.38 [1.13,1.67] respectively). In addition, individuals with these sleep traits exhibited alterations in several glycemic traits compared with non-affected controls. In MR analysis, the primary analysis demonstrated causal effects of 2hGlu on risks of EDS (OR [95% CI] = 1.022 [1.002,1.042]) and insomnia (OR [95% CI] = 1.020[1.001,1.039]). Furthermore, FINS was associated with short sleep duration (OR [95% CI] = 1.043 [1.018,1.068]), which reversely presented a causal influence on HbA1c (β [95% CI] = 0.131 [0.022,0.239]). These results were confirmed by sensitivity analysis. Conclusion Our results suggested mutual risk and causal associations between the sleep traits and glycemic traits, shedding new light on clinical strategies for preventing sleep disorders and regulating glucose metabolism. Future studies targeting these associations may hold a promising prospect for public health.
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Affiliation(s)
- Minhan Yi
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Quanming Fei
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Medical School, Central South University, Changsha, China
| | - Ziliang Chen
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- School of Life Sciences, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wangcheng Zhao
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Medical School, Central South University, Changsha, China
| | - Kun Liu
- School of Life Sciences, Central South University, Changsha, China
| | - Shijie Jian
- School of Life Sciences, Central South University, Changsha, China
| | - Bin Liu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Meng He
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoli Su
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Zarean E, Looha MA, Amini P, Ahmadi A, Dugué PA. Sleep characteristics of middle-aged adults with non-alcoholic fatty liver disease: findings from the Shahrekord PERSIAN cohort study. BMC Public Health 2023; 23:312. [PMID: 36774488 PMCID: PMC9922458 DOI: 10.1186/s12889-023-15251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 02/09/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Several studies have reported short sleep duration in people with non-alcoholic fatty liver disease (NAFLD) but other sleep characteristics have been less studied. We aimed to assess the cross-sectional association of NAFLD with sleep duration and quality in an Iranian population sample. METHODS We used data from 9,151 participants in the Shahrekord Prospective Epidemiological Research Studies in Iran (PERSIAN) Cohort Study, including 1,320 that were diagnosed with NAFLD. Log-binomial regression models sequentially adjusted for sociodemographic, lifestyle, clinical and biological variables were used to estimate relative risks (RR) and 95% confidence intervals (95% CI) for the association between NAFLD and sleep characteristics. RESULTS Participants with NAFLD had shorter sleep duration, later wake-up time and bedtime, worse sleep efficiency, and more frequent daytime napping and use of sleeping pills, in age- and sex-adjusted models. After controlling for sociodemographic, lifestyle, clinical, and biological variables the associations remained strong for sleep efficiency (per 10%, RR = 0.92, 95%CI: 0.88-0.96) and use of sleeping pills (RR = 1.48, 95%CI: 1.17-1.88). The association between NAFLD and sleep efficiency was stronger in participants aged > 60 years (RR = 0.81, 0.70-0.93) and 40-60 years (RR = 0.87, 0.82-0.94), compared with those aged < 40 years (P-heterogeneity < 0.001). More frequent daytime napping in participants with NAFLD, compared with non-NAFLD, was observed in males but not females (P-heterogeneity = 0.007), and in those with body mass index (BMI) < 30 but not in obese participants (P-heterogeneity < 0.001). CONCLUSIONS Diagnosis of NAFLD is associated with several poor sleep characteristics in middle-aged Iranians. Although longitudinal studies would help to clarify the direction of causality, our study shows that poor sleep is an important aspect of NAFLD.
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Affiliation(s)
- Elaheh Zarean
- grid.440801.90000 0004 0384 8883Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran ,grid.1002.30000 0004 1936 7857Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Mehdi Azizmohammad Looha
- grid.411600.2Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Payam Amini
- grid.411746.10000 0004 4911 7066Department of Biostatistics, School of Public Health, IRAN University of Medical Sciences, Tehran, Iran
| | - Ali Ahmadi
- Department of Epidemiology and Biostatistics, School of Health and, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Pierre-Antoine Dugué
- grid.1002.30000 0004 1936 7857Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia ,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XCentre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC Australia
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Yang J, Luo S, Li R, Ju J, Zhang Z, Shen J, Sun M, Fan J, Xia M, Zhu W, Liu Y. Sleep Factors in Relation to Metabolic Dysfunction-Associated Fatty Liver Disease in Middle-Aged and Elderly Chinese. J Clin Endocrinol Metab 2022; 107:2874-2882. [PMID: 35900115 DOI: 10.1210/clinem/dgac428] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Accumulating evidence implies that sleep disturbance is involved in metabolic disorders. OBJECTIVE We comprehensively evaluated the association between various dimensions of sleep behaviors and the risk for metabolic dysfunction-associated fatty liver disease (MAFLD). METHODS In this cross-sectional study of 5011 participants with self-reported sleep behaviors and radiologically diagnosed MAFLD, a comprehensive healthy sleep score was generated to evaluate the associations between sleep behaviors and MAFLD risk using multivariate logistic regression adjusting for demographics, lifestyles, medication, and metabolic comorbidities. Furthermore, mediation analysis was utilized to assess the extent to which obesity explains the effect of sleep quality on MAFLD risk. RESULTS Late bedtime, snoring, and daytime napping for over 30 minutes significantly associated with an increased risk of MAFLD, with odds ratios (OR) of 1.37 (95% CI 1.10, 1.70), 1.59 (95% CI 1.33, 1.91), and 1.17 (95% CI 1.02, 1.35), respectively, after full adjustments including obesity. Participants with disturbance in nighttime sleep and prolonged daytime napping showed the highest risk for MAFLD (OR 2.38, 95% CI 1.73, 3.27). Each additional increase of healthy sleep score was associated with a 16% reduction in MAFLD risk. Further stratified analysis revealed that people with a sedentary lifestyle and central obesity experienced more prominent adverse effects from poor sleep quality than others. Moreover, obesity accounted for only 20.77% of the total effect of sleep quality on MAFLD risk. CONCLUSIONS Sleep behaviors, both cumulatively and individually, are associated with MAFLD risk. Public health awareness and strategies should be encouraged to curb MAFLD.
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Affiliation(s)
- Jialu Yang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, China
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shiyun Luo
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, China
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Rui Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, China
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jingmeng Ju
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, China
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhuoyu Zhang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, China
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jichuan Shen
- Department of Toxicology, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Minying Sun
- Department of Toxicology, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jiahua Fan
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, China
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Min Xia
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, China
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wei Zhu
- Department of Toxicology, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yan Liu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, China
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Yu L, Lin C, Chen X, Teng Y, Zhou S, Liang Y. A Meta-Analysis of Sleep Disorders and Nonalcoholic Fatty Liver Disease: Potential Causality and Symptom Management. Gastroenterol Nurs 2022; 45:354-363. [PMID: 35913418 DOI: 10.1097/sga.0000000000000658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/29/2021] [Indexed: 01/10/2023] Open
Abstract
Nonalcoholic fatty liver disease is a type of metabolic disease, and recent research indicates that it may be associated with sleep disorders. We conducted a meta-analysis of current studies to estimate the associations between nonalcoholic fatty liver disease and sleep situation, including sleep duration, daytime sleepiness, and sleep disorder. This study follows the checklist of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Articles in the recent 10 years were searched from five databases. Eighteen articles, which met the eligibility criteria, were included in this meta-analysis. The results show that patients with nonalcoholic fatty liver disease have a shorter sleep duration and higher Epworth Sleepiness Scale score. Patients with short sleep duration (≤6 hours per night) or with obstructive sleep apnea have a higher risk of nonalcoholic fatty liver disease. In conclusion, there is a significant association between nonalcoholic fatty liver disease and sleep disorders in the included studies. In addition, patients with nonalcoholic fatty liver disease may have more severe daytime sleepiness and shorter sleep duration. More attention should be paid to the sleep situation of nonalcoholic fatty liver disease patients to potentially slow the disease progression.
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Affiliation(s)
- Lebing Yu
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
| | - Chenli Lin
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
| | - Xinhe Chen
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
| | - Yuxin Teng
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
| | - Shuang Zhou
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
| | - Yinji Liang
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
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Kaya E, Yilmaz Y. Metabolic-associated Fatty Liver Disease (MAFLD): A Multi-systemic Disease Beyond the Liver. J Clin Transl Hepatol 2022; 10:329-338. [PMID: 35528971 PMCID: PMC9039705 DOI: 10.14218/jcth.2021.00178] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/19/2021] [Accepted: 09/17/2021] [Indexed: 02/05/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a multisystemic clinical condition that presents with a wide spectrum of extrahepatic manifestations, such as obesity, type 2 diabetes mellitus, metabolic syndrome, cardiovascular diseases, chronic kidney disease, extrahepatic malignancies, cognitive disorders, and polycystic ovarian syndrome. Among NAFLD patients, the most common mortality etiology is cardiovascular disorders, followed by extrahepatic malignancies, diabetes mellitus, and liver-related complications. Furthermore, the severity of extrahepatic diseases is parallel to the severity of NAFLD. In clinical practice, awareness of the associations of concomitant diseases is of major importance for initiating prompt and timely screening and multidisciplinary management of the disease spectrum. In 2020, a consensus from 22 countries redefined the disease as metabolic (dysfunction)-associated fatty liver disease (MAFLD), which resulted in the redefinition of the corresponding population. Although the patients diagnosed with MAFLD and NAFLD mostly overlap, the MAFLD and NAFLD populations are not identical. In this review, we compared the associations of key extrahepatic diseases between NAFLD and MAFLD.
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Affiliation(s)
- Eda Kaya
- Department of Internal Medicine, Ruhr University Bochum, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
- Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey
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Umbro I, Fabiani V, Fabiani M, Angelico F, Del Ben M. Association between non-alcoholic fatty liver disease and obstructive sleep apnea. World J Gastroenterol 2020; 26:2669-2681. [PMID: 32523319 PMCID: PMC7265151 DOI: 10.3748/wjg.v26.i20.2669] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/26/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is an emerging liver disease and currently the most common cause of incidental abnormal liver tests. The pathogenesis of NAFLD is multifactorial and many mechanisms that cause fatty liver infiltration, inflammation, oxidative stress and progressive fibrosis have been proposed. Obstructive sleep apnea (OSA) may be linked with the pathogenesis and the severity of NAFLD.
AIM To study the association between NAFLD and OSA considering also the efficacy of continuous positive airway pressure (CPAP) treatment.
METHODS A PubMed search was conducted using the terms “non-alcoholic fatty liver disease AND (obstructive sleep apnea OR obstructive sleep disorders OR sleep apnea)”. Research was limited to title/abstract of articles published in English in the last 5 years; animal and child studies, case reports, commentaries, letters, editorials and meeting abstracts were not considered. Data were extracted on a standardized data collection table which included: First author, publication year, country, study design, number of patients involved, diagnosis and severity of OSA, diagnosis of NAFLD, patient characteristics, results of the study.
RESULTS In total, 132 articles were initially retrieved on PubMed search and 77 in the last five years. After removal of irrelevant studies, 13 articles were included in the qualitative analysis. There was a total of 2753 participants across all the studies with a mean age between 42 and 58 years. The proportion of males ranged from 21% to 87.9% and the mean body mass index ranged from 24.0 to 49.9 kg/m2. The results of this review showed an increased prevalence of NAFLD in patients with diagnosis of OSA, even in the absence of coexisting comorbidities such as obesity or metabolic syndrome. Furthermore, the severity of NAFLD is associated with the increase in OSA severity. Effective CPAP treatment, although not always decisive, may stabilize or slow NAFLD progression with benefits on metabolic and cardiovascular functions.
CONCLUSION In NAFLD patients, although asymptomatic, it is recommended to systematically perform polysomnography in order to early and better treat them before the development of potentially life threatening systemic dysfunctions.
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Affiliation(s)
- Ilaria Umbro
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome 00161, Italy
| | - Valerio Fabiani
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome 00123, Italy
| | - Mario Fabiani
- Department of Sense Organs, Sapienza University of Rome, Rome 00161, Italy
| | - Francesco Angelico
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome 00161, Italy
| | - Maria Del Ben
- Department of Clinical, Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Rome 00161, Italy
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8
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Maâlej S, Jedidi S, Hannachi H, Gharsalli H, Sahnoun I, Neji H, El Gharbi L. Prévalence et facteurs de risque de stéatose hépatique chez les adultes tunisiens atteints de syndrome d’apnées hypopnées obstructives du sommeil. Rev Mal Respir 2020; 37:8-14. [DOI: 10.1016/j.rmr.2019.11.643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/07/2019] [Indexed: 11/24/2022]
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9
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Wijarnpreecha K, Thongprayoon C, Panjawatanan P, Ungprasert P. Insomnia and risk of nonalcoholic fatty liver disease: A systematic review and meta-analysis. J Postgrad Med 2019; 63:226-231. [PMID: 28862239 PMCID: PMC5664866 DOI: 10.4103/jpgm.jpgm_140_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: This sudy aims to investigate the association between insomnia or excessive daytime sleepiness (EDS) and risk of nonalcoholic fatty liver disease (NAFLD). Methods: We searched published studies indexed in MEDLINE and EMBASE database from inception to December 2015. Studies that reported odds ratios (ORs), risk ratios, hazard ratios or standardized incidence ratio with 95% confidence intervals (CI) comparing the risk of NAFLD among participants who had insomnia or EDS versus those without insomnia or EDS were included. Pooled ORs and 95% CI were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. Cochran's Q test and I2 statistic were used to determine the between-study heterogeneity. Results: Our search strategy yielded 2117 potentially relevant articles (781 articles from MEDLINE and 1336 articles from EMBASE). After comprehensive review, seven studies (three cross-sectional studies and four case–control studies) were found to be eligible and were included in the meta-analysis. The risk of NAFLD in participants who had insomnia was significantly higher with the pooled OR of 1.13 (95% CI, 1.00–1.27). The statistical heterogeneity was moderate with an I2 of 62%. Elevated risk of NAFLD was also observed among participants with EDS even though the 95% CI was wider and did not reach statistical significance (pooled OR 2.21; 95% CI, 0.84–5.82). The statistical heterogeneity was moderate with an I2 of 62%. Conclusions: Our study demonstrated an increased risk of NAFLD among participants who had insomnia or EDS. Whether this association is causal needs further investigations.
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Affiliation(s)
- K Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - C Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - P Panjawatanan
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - P Ungprasert
- Department of Internal Medicine, Division of Rheumatology, Rochester, Minnesota, USA; Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Kim JH, Jung DH, Kwon YJ, Lee JI, Shim JY. The impact of the sleep duration on NAFLD score in Korean middle-aged adults: a community-based cohort study. Sleep Med 2019; 57:144-150. [PMID: 30991275 DOI: 10.1016/j.sleep.2019.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Accumulated evidences indicates that sleep duration and sleep quality may potentially trigger the development of non-alcoholic fatty liver disease (NAFLD), but no studies have explored this causality. In this study, we aimed to investigate the effect of sleep duration on the incidence of NAFLD in Korean middle-aged adults. METHODS All participants were selected from the cohort of the Korean Genome and Epidemiology Study (KoGES) for a 10-year period. NAFLD was defined by Fatty Liver Index (FLI), NAFLD liver fat score (NLFS), Hepatic Steatosis Index (HSI) and Lipid Accumulation Product (LAP). Multiple logistic regression analysis was used to assess the relationship between sleep duration and NAFLD defined by NAFLD scores. ANCOVA and Spline curve was also used to verify the differences in means of NAFLD scores according to the four sleep duration groups. RESULTS In comparison with those of individuals in the reference group, the OR (95% CI) for NAFLD was 2.230 (1.304-3.813) for group of people who slept more than 8 h, 1.869 (1.298-2.691) for 7-8 h after adjusting for several confounding factors. The odds ratio for the incidence of NAFLD was 1.462 (1.029-2.077) for the group of people who sleep more than 8 h, 1.271 (1.001-1.615) for 7-8 h after adjusting for age, sex, BMI, SBP, DBP, TG, HDL, FDG, smoking, physical activity, daytime napping and night-time shifting (p < 0.01). CONCLUSION These findings indicate a relationship between long sleep duration and the elevation of NAFLD scores and support the causality of sleep duration and incidence of NAFLD in Korean middle-aged adults.
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Affiliation(s)
- Ji-Hye Kim
- Department of Family Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Dong-Hyuk Jung
- Department of Family Medicine, Yonsei University College of Medicine, Yongin Severance Hospital, Seoul, Republic of Korea
| | - Yu-Jin Kwon
- Department of Family Medicine, Yonsei University College of Medicine, Yongin Severance Hospital, Seoul, Republic of Korea
| | - Jung-Il Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Jae-Yong Shim
- Department of Family Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.
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11
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Chou YT, Cheng HJ, Wu JS, Yang YC, Chou CY, Chang CJ, Lu FH. The association of sleep duration and sleep quality with non-alcoholic fatty liver disease in a Taiwanese population. Obes Res Clin Pract 2018; 12:500-505. [PMID: 29929928 DOI: 10.1016/j.orcp.2018.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 04/22/2018] [Accepted: 05/19/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The association of sleep duration/quality with nonalcoholic fatty liver disease (NAFLD) is inconclusive. Several important covariates were not adjusted concomitantly in some studies, and the severity of NAFLD was not considered. Furthermore, the gender impact of sleep duration or sleep quality on NAFLD remains unclear. We thus aimed to examine the association of sleep duration and quality with NAFLD by gender in a Taiwanese population. METHODS A total of 6663 subjects aged 18 years or more were enrolled. The severity of NAFLD was divided into mild, moderate, and severe degrees based on ultrasound findings. The sleep duration was classified into three groups: short (<6h), normal (6-8h), and long (>8h). Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, and poor sleep quality was defined as a global PSQI score greater than 5. RESULTS After adjustment for potential confounders, multinomial logistic regression showed that poor sleep quality was negatively associated with both mild and moderate-to-severe NAFLD in males, but sleep duration was not independently related to NAFLD. In females, sleep condition was not related to NAFLD. CONCLUSIONS Poor sleep quality but not sleep duration was associated with a lower risk of not only moderate to severe but also mild NAFLD in males. In females, the association of sleep quality and duration with the risk of NAFLD was insignificant.
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Affiliation(s)
- Yu-Tsung Chou
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | - Hsiang-Ju Cheng
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chieh-Ying Chou
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Hwa Lu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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12
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Zhang XB, Zeng HQ, Du YP, Lyu Z, Zhan FF. High-sensitivity cardiac troponin T in obstructive sleep apnea patients without cardiovascular diseases: Efficacy of CPAP treatment. Chron Respir Dis 2017; 15:157-164. [PMID: 29117795 PMCID: PMC5958472 DOI: 10.1177/1479972317740127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The aims of this article were to determine the levels of serum high-sensitivity cardiac troponin T (hs-cTnT) in obstructive sleep apnea (OSA) patients without cardiovascular disease (CVD) and to assess the efficacy of continuous positive airway pressure (CPAP). Snorers referred for polysomnography (PSG) for the investigation of OSA were eligible and hs-cTnT levels measured in our pilot study. Hs-cTnT was measured again after 3 months of CPAP treatment in participants with severe OSA. A total of 93 participants recruited after PSG. When compared with simple snoring group, severe OSA group had comparable higher hs-cTnT (7.5 ± 3.0 vs. 5.0 ± 2.1; p < 0.05). Hs-cTnT was positively correlated with apnea hypopnea index, and oxygen desaturation index (r = 0.283, 0.282; p = 0.006, 0.006, respectively). Hs-cTnT levels were not significantly altered in 28 individuals who received 3 months of CPAP treatment (8.4 ± 2.4 vs.7.6 ± 2.1; p = 0.064). Elevated hs-cTnT levels were observed in severe OSA patients without CVD, and CPAP treatment had no influence on this levels.
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Affiliation(s)
- Xiao-Bin Zhang
- 1 Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.,2 Teaching Hospital of Fujian Medical University, Siming District, Xiamen, Fujian, China
| | - Hui-Qing Zeng
- 1 Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.,2 Teaching Hospital of Fujian Medical University, Siming District, Xiamen, Fujian, China
| | - Yan-Ping Du
- 1 Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.,2 Teaching Hospital of Fujian Medical University, Siming District, Xiamen, Fujian, China
| | - Zhi Lyu
- 1 Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.,2 Teaching Hospital of Fujian Medical University, Siming District, Xiamen, Fujian, China
| | - Feng-Fu Zhan
- 1 Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.,2 Teaching Hospital of Fujian Medical University, Siming District, Xiamen, Fujian, China
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Trovato FM, Martines GF, Brischetto D, Trovato G, Catalano D. Neglected features of lifestyle: Their relevance in non-alcoholic fatty liver disease. World J Hepatol 2016; 8:1459-1465. [PMID: 27957244 PMCID: PMC5124717 DOI: 10.4254/wjh.v8.i33.1459] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/04/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigated in non-alcoholic-fatty-liver-disease (NAFLD), with ultrasound (US)-detected fatty liver, and in a group of non-alcoholic and otherwise healthy subjects, relationship of neglected features of lifestyle with NAFLD and obesity.
METHODS Five hundred and thirty-two NAFLD and 667 non-NAFLD healthy subjects, age 21-60 years were studied. Severity of liver steatosis was assessed by US bright liver score. The adherence to mediterranean diet score (AMDS) was assessed on the basis of a 1-wk recall computerized questionnaire which included a detailed physical activity reports (Baecke questionnaire). The western dietary profile score, as a simplified paradigm of unhealthy diet, a questionnaire quantifying sun exposure score and a sleep habits questionnaires provided a further comprehensive lifestyle assessment.
RESULTS Body mass index (BMI), insulin resistance (HOMA), and triglycerides, poorer adherence to a mediterranean diet profile, sedentary habits, minor sun exposure and use of “western diet” foods are greater in NAFLD. Multiple linear regression analysis, weighted by years of age, displays BMI, HOMA and AMDS as the most powerful independent predictors of fatty liver severity; however, also the physical activity score, the western diet habit and the sun exposure score are acting inside the model with significant independent effects.
CONCLUSION Articulated clinical intervention, according to our results, are justified in NAFLD and can be pursued addressing by focused intervention nutritional profile, physical exercise mainly in open-air subsets for enhancing sun exposure and healthier sleep duration and rhythm.
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Wijarnpreecha K, Thongprayoon C, Panjawatanan P, Ungprasert P. Short sleep duration and risk of nonalcoholic fatty liver disease: A systematic review and meta-analysis. J Gastroenterol Hepatol 2016; 31:1802-1807. [PMID: 27029776 DOI: 10.1111/jgh.13391] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/07/2016] [Accepted: 03/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. Several studies have suggested that short sleep duration could be a risk factor for NAFLD. However, results of those reports are inconsistent. This meta-analysis was conducted with an attempt to summarize all available data. METHODS A comprehensive literature review was performed using MEDLINE and EMBASE database. Studies that reported relative risks, odd ratios or hazard ratios comparing the risk of NAFLD among participants who had short sleep duration versus those with longer sleep duration were included. Pooled risk ratios and 95% confidence interval were calculated using a random-effect, generic inverse variance method. RESULTS Six studies met the eligibility criteria and were included in the meta-analysis. The risk of NAFLD in participants who had short sleep duration was significantly higher than participants with longer sleep duration with pooled risk ratios of 1.19 (95% confidence interval, 1.04-1.36, I2 = 0%). CONCLUSIONS Our study demonstrated a small but significantly increased risk of NAFLD among participants who had short sleep duration.
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Affiliation(s)
- Karn Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA
| | | | - Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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LUSTOSA MF, SÁ CMATD, CAVALCANTI AC, MEDEIROS RABD, NOVA LPV, PEDROSA RP. Perfis metabólico e nutricional como preditores da síndrome da apneia obstrutiva do sono. REV NUTR 2016. [DOI: 10.1590/1678-98652016000500005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo: Correlacionar os perfis metabólico e nutricional com a presença e gravidade da síndrome da apneia obstrutiva do sono. Métodos: Estudo transversal com pacientes adultos e idosos, de ambos os sexos, atendidos no Laboratório do Sono e Coração do Pronto Socorro Cardiológico Universitário de Pernambuco, entre junho e setembro de 2014. Os pacientes se submeteram à polissonografia, à bioimpedância elétrica e a aferições antropométricas. Foram verificadas a presença da síndrome metabólica e outras morbidades. Resultados: A amostra total foi constituída por 50 pacientes, com idade média de 57,52±9,80 anos, sendo que 94% receberam diagnóstico de síndrome da apneia obstrutiva do sono e 74% possuíam síndrome metabólica. As seguintes médias foram obtidas: índice de massa corporal (31,54±5,82 kg/m2); circunferência do pescoço (39,14±4,33 cm); circunferência da cintura (106,72±11,22 cm); diâmetro abdominal sagital (23,00 cm [21,00-24,00]). O índice de massa corporal, a circunferência da cintura e o diâmetro abdominal sagital apresentaram valores mais elevados (p<0,05) entre os pacientes com síndrome da apneia obstrutiva do sono grave, quando comparados aqueles com a forma leve. O diâmetro abdominal sagital apresentou moderada correlação com o índice de apneia e hipopneia e a gordura corporal apresentou fraca correlação. Conclusão: A obesidade, a circunferência do pescoço, o diâmetro abdominal sagital e a síndrome metabólica tiveram associação positiva com a gravidade da síndrome da apneia obstrutiva do sono. Dentre os parâmetros antropométricos avaliados, o diâmetro abdominal sagital mostrou ser o mais adequado preditor para avaliar a presença e gravidade da síndrome da apneia obstrutiva do sono.
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Sleep Duration and the Risk of Fatty Liver Disease: A Systematic Review and Meta-analysis. Sci Rep 2016; 6:31956. [PMID: 27549512 PMCID: PMC4994071 DOI: 10.1038/srep31956] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 07/28/2016] [Indexed: 12/11/2022] Open
Abstract
Recent studies have reported inconsistent results on the association between sleep duration and the risk of fatty liver disease (FLD). Thus, we quantitatively evaluated this association by performing a systematic review and meta-analysis, based on a comprehensive electronic search in databases of PubMed, Web of Science, EMBASE, ClinicalTrials.gov, Wanfangdata and Chinese National Knowledge Infrastructure (CNKI) (updated to April 2016). Multivariate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were extracted and pooled by using a random-effects model. Eight eligible studies involving 97,371 participants were included. We found that neither short nor long sleep duration was significantly related with FLD risk. For short sleep duration, the pooled OR was 1.17 (95% CI = 0.98–1.38), and for long sleep duration, the pooled OR was 1.01 (95% CI = 0.72–1.41). Subgroup analyses by sex, outcome, and exposure reference also did not identify any effect of sleep duration on FLD onset. In summary, our findings suggested that short or long sleep duration was not significantly associated with FLD risk. Further cohort studies with refined designs are still warranted to validate our results.
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