Abstract
Although nonalcoholic fatty liver disease (NAFLD) is associated with obstructive sleep apnea syndrome (OSAS), studies on the direct relationship between NAFLD and snoring, an early symptom of OSAS, are limited. We evaluated whether snorers had higher risk of developing NAFLD. The study was performed using data of the Tongmei study (cross-sectional survey, 2,153 adults) and Kailuan study (ongoing prospective cohort, 19,587 adults). In both studies, NAFLD was diagnosed using ultrasound; snoring frequency was determined at baseline and classified as none, occasional (1 or 2 times/week), or habitual (≥3 times/week). Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals were estimated using logistic and Cox models, respectively. During 10 years’ follow-up in Kailuan, 4,576 individuals with new-onset NAFLD were identified at least twice. After adjusting confounders including physical activity, perceived salt intake, body mass index (BMI), and metabolic syndrome (MetS), multivariate-adjusted ORs and HRs for NAFLD comparing habitual snorers to non-snorers were 1.72 (1.25–2.37) and 1.29 (1.16–1.43), respectively. These associations were greater among lean participants (BMI < 24) and similar across other subgroups (sex, age, MetS, hypertension). Snoring was independently and positively associated with higher prevalence and incidence of NAFLD, indicating that habitual snoring is a useful predictor of NAFLD, particularly in lean individuals.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is associated with obstructive sleep apnea syndrome (OSAS), studies on the direct relationship between nonalcoholic fatty liver disease (NAFLD) and snoring, an early symptom of OSAS, are limited
In Tongmei, the prevalence of NAFLD diagnosed via abdominal ultrasound was 29.6% (638/2,153), and those participants were more likely to be men, age ≥ 45 years, and to exhibit higher daily total energy intake, snoring, metabolic syndrome (MetS) and its components, higher body mass index (BMI), and elevated alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma glutamyl transpeptidase (GGT)
During the 10-year follow-up, 4,576 patients with incident NAFLD were identified in Kailuan
Summary
Nonalcoholic fatty liver disease (NAFLD) is associated with obstructive sleep apnea syndrome (OSAS), studies on the direct relationship between NAFLD and snoring, an early symptom of OSAS, are limited. After adjusting confounders including physical activity, perceived salt intake, body mass index (BMI), and metabolic syndrome (MetS), multivariate-adjusted ORs and HRs for NAFLD comparing habitual snorers to non-snorers were 1.72 (1.25–2.37) and 1.29 (1.16–1.43), respectively. These associations were greater among lean participants (BMI < 24) and similar across other subgroups (sex, age, MetS, hypertension). We conducted the first cross-sectional study and first independent validation cohort study designed to investigate whether individuals who self-reported snoring had a higher prevalence and incidence of NAFLD. 285 missing drinking data at baseline and during follow-up were ldd 75 with cirrhosis at baseline or during follow-up were excluded
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