Abstract
Background/aimsGiven the increased incidence of obstructive sleep apnea (OSA) among patients with nonalcoholic fatty liver disease (NAFLD), noninvasive screening methods are urgently needed to screen for OSA risk in these patients when conducting an office-based assessment of hepatic steatosis. Therefore, we investigated the controlled attenuation parameter (CAP) and hepatic steatosis index (HSI) in patients with and without OSA and developed screening models to detect OSA.MethodsWe retrospectively reviewed the medical records of all adult snorers with suspected NAFLD undergoing liver sonography between June 2017 and June 2020. Records encompassed CAP and HSI data as well as data collected during in-hospital full-night polysomnography. The multivariate logistic regression models were constructed to explore the predictors of OSA risk. Furthermore, model validation was performed based on the medical records corresponding to the July 2020–June 2021 period.ResultsA total of 59 patients were included: 81.4% (48/59) were men, and the mean body mass index (BMI) was 26.4 kg/m2. Among the patients, 62.7% (37/59) and 74.6% (44/59) (detected by the HSI and CAP, respectively) had NAFLD, and 78% (46/59) were diagnosed with OSA on the basis of polysomnography. Three screening models based on multivariate analysis were established. The model combining male sex, a BMI of > 24.8, and an HSI of > 38.3 screened for OSA risk the most accurately, with an area under the receiver operating characteristic curve of 0.81 (sensitivity: 78%; specificity: 85%; and positive and negative predictive values: 95% and 52%, respectively) in the modeling cohort. An accuracy of 70.0% was achieved in the validation group.ConclusionsThe combination screening models proposed herein provide a convenient, noninvasive, and rapid screening tool for OSA risk and can be employed while patients receive routine hepatic check-ups. These models can assist physicians in identifying at-risk OSA patients and thus facilitate earlier detection and timely treatment initiation.
Highlights
Obstructive sleep apnea (OSA) is common, with a prevalence of 2%–4% in the general population and 35–45% in those who are obese [1]
After 35 patients were excluded from the analysis (4 patients had previously been diagnosed as having OSA, 14 patients had a history of excessive alcohol consumption, and 17 patients had a history of viral hepatitis or hepatic cancer), 59 patients were enrolled
Correlations between hepatic indices, body mass index (BMI), and OSA severity parameters Significant correlations were observed between the controlled attenuation parameter (CAP) and the following OSA severity indices: apnea–hypopnea index (AHI) (r = 0.35, p < 0.01), mean Oxygen saturation measured by pulse oximetry (SpO2) (r = −0.35, p < 0.01), minimal SpO2 (r = −0.29, p < 0.05), oxygen desaturation index (ODI) ≥ 3% (ODI3; r = 0.33, p < 0.01), and T90% (r = 0.39, p < 0.01; Table 2)
Summary
Obstructive sleep apnea (OSA) is common, with a prevalence of 2%–4% in the general population and 35–45% in those who are obese [1]. In OSA, the upper airway collapses during sleep, which leads to snoring, hypercapnia, and complications related to chronic intermittent hypoxemia (CIH) [2, 3]. CIH is independently related to dyslipidemia in nonalcoholic fatty liver disease (NAFLD) [6, 7], exacerbating NAFLD and advancing liver fibrosis [8]. The obesity epidemic has increased the incidence of NAFLD [10] and the risk of OSA [11]. The prevalence of NAFLD is higher in patients with OSA [12]. It is crucial to screen patients with OSA risk for NAFLD to detect the condition at an early stage
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