Nonalcoholic fatty liver disease is associated with the development of obstructive sleep apnea

Goh Eun Chung,Jeong-Ju Yoo,Kyungdo Han,Young Chang,Eun Ju Cho,Sang-Hyun Park,Dong Wook Shin,Su Jong Yu,Yuri Cho

doi:10.1038/s41598-021-92703-0

Abstract

Increasing evidence suggests that obstructive sleep apnea (OSA) is a metabolic syndrome-related disease; however, the association between nonalcoholic fatty liver disease (NAFLD) and OSA is not firmly established. In this study, we investigated the relationship between NAFLD and OSA in a general population drawn from a nationwide population-based cohort. Data from the Korean National Health Insurance System between January 2009 and December 2009 were analyzed using Cox proportional hazards model. NAFLD was defined as a fatty liver index (FLI) ≥ 60 in patients without excessive alcohol consumption (who were excluded from the study). Newly diagnosed OSA during follow-up was identified using claims data. Among the 8,116,524 participants, 22.6% had an FLI score of 30–60 and 11.5% had an FLI ≥ 60. During median follow-up of 6.3 years, 45,143 cases of incident OSA occurred. In multivariable analysis, the risk of OSA was significantly higher in the higher FLI groups (adjusted hazard ratio [aHR] 1.15, 95% confidence interval [CI] 1.12–1.18 for FLI 30–60 and aHR 1.21, 95% CI 1.17–1.26 for FLI ≥ 60). These findings were consistent regardless of body mass index and presence of abdominal obesity. In conclusion, a high FLI score may help identify individuals with a high risk of OSA. Understanding the association between NAFLD and OSA may have clinical implications for risk-stratification of individuals with NAFLD.

Highlights

Increasing evidence suggests that obstructive sleep apnea (OSA) is a metabolic syndrome-related disease; the association between nonalcoholic fatty liver disease (NAFLD) and OSA is not firmly established
NAFLD may progress in some instances to steatohepatitis, hepatic fibrosis, and cirrhosis[9] and hepatic steatosis is frequently associated with other disorders, including cardiovascular d isease10, diabetes[11], chronic kidney d isease[12], and colorectal c ancer[13]
Previous studies regarding the association between NAFLD and OSA were conducted to investigate the risk of hepatic steatosis in patients with OSA

Summary

Introduction

Increasing evidence suggests that obstructive sleep apnea (OSA) is a metabolic syndrome-related disease; the association between nonalcoholic fatty liver disease (NAFLD) and OSA is not firmly established. Abbreviations OSA Obstructive sleep apnea NAFLD Nonalcoholic fatty liver disease FLI Fatty liver index HR Hazard ratio CI Confidence interval NHIS National Health Insurance System ICD International Classification of Diseases BMI Body mass index WC Waist circumference GGT Gamma-glutamyl transferase LAP Lipid accumulation product. Obstructive sleep apnea (OSA) is characterized by recurrent collapse of the upper respiratory tract during sleep, leading to intermittent hypoxia, snoring, and sleep fragmentation It is a prevalent disease, affecting 7–20% of Institute, Seoul National University College of Medicine, 101 Daehak‐no, Jongno‐gu, Seoul 03080, Republic of Korea. Previous studies regarding the association between NAFLD and OSA were conducted to investigate the risk of hepatic steatosis in patients with OSA. We used a nationwide population-based cohort of participants in a health screening program to investigate the risk of incident OSA during follow-up in people with hepatic steatosis

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