Non-alcoholic fatty liver disease among patients with sleep disorders: a Nationwide study of Taiwan

Yu-Ting Wei,Cheng-Yu Lin,Yin-Fan Chang,Che-Chen Lin,Jin-Shang Wu,Chen-Long Wu,How-Ran Guo,Peng-Yi Lee,Hsuan-Ju Chen

doi:10.1186/s12876-020-1178-7

Abstract

BackgroundNonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases. Studies have shown that sleep apnea is associated with NAFLD. However, studies on the association between sleep disorders in general and NAFLD are limited. We conducted a nationwide population-based longitudinal study to evaluate this potential association.MethodsWe identified patients diagnosed with sleep disorders in the years 2000 through 2005 in Taiwan using the National Health Insurance Research Database and selected an equal number of patients without sleep disorders from the same database as the comparison cohort. The patients were followed from the index date to the diagnosis of NAFLD or the end of 2013. We used Cox proportional hazards models to estimate the risk of NAFLD associated with sleep disorders.ResultsA total of 33,045 patients with sleep disorders were identified. The incidence of NAFLD was 14.0 per 10,000 person-year in patients with sleep disorders and 6.2 per 10,000 person-year in the comparison cohort. The adjusted hazard ratio (AHR) of NAFLD associated with sleep disorders was 1.78 (95% confidence interval [95%CI]: 1.46–2.16), and other independent risk factors included male sex (AHR = 1.31, 95%CI: 1.12–1.54), age 40–59 years (AHR = 1.49, 95%CI: 1.21–1.82), and dyslipidemia (AHR = 2.51, 95%CI: 2.08–3.04). In the subgroup analyses, both patients with (AHR = 2.24, 95%CI: 1.05–4.77) and without (AHR = 1.77, 95%CI: 1.46–2.15) sleep apnea had an increased risk of NAFLD.ConclusionsSleep disorders are associated with NAFLD, even in patients without sleep apnea. Further studies are warranted to explore the mechanisms of the association.

Highlights

Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases
Patients with sleep disorders (SD) are at increased risks of obesity, insulin resistance, dyslipidemia, hypertension, diabetes mellitus [16], and cardiovascular disease [17], which have all been reported to be associated with NAFLD [18, 19]
Using “sleep disorder” and “non-alcoholic fatty liver disease” as the keywords to search the literature indexed in the PubMed, we found that most of the previous studies were focused on sleep apnea, and all the limited studies on NAFLD associated with SD in general were cross-sectional studies, which may fall prey to the problem of “inverse causation,” i.e. NAFLD being a cause instead of an outcome of SD

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases. Studies have shown that sleep apnea is associated with NAFLD. Studies on the association between sleep disorders in general and NAFLD are limited. We conducted a nationwide population-based longitudinal study to evaluate this potential association. Sleep apnea is a kind of sleep disorders (SD). It refers to momentary, often cyclical, cessations in breathing rhythm, sufficient to cause significant arterial hypoxemia and hypercapnia [8]. Many studies have been conducted on the association between sleep apnea and NAFLD, and the pooled odds ratios were approximately 2 to 3 in. Patients with SD are at increased risks of obesity, insulin resistance, dyslipidemia, hypertension, diabetes mellitus [16], and cardiovascular disease [17], which have all been reported to be associated with NAFLD [18, 19]

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Conclusion