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Relationship between obstructive sleep apnea and nonalcoholic fatty liver disease in nonobese adults

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Abstract

Purpose

Obstructive sleep apnea (OSA) is closely related to nonalcoholic fatty liver disease (NAFLD), though the mechanism is not conclusive as obesity is a confounder. The objective of this observational study was to investigate the correlation between these disorders in nonobese subjects.

Methods

We consecutively enrolled nonobese individuals undergoing polysomnography and abdominal ultrasonography and analyzed differences in NAFLD patients grouped by the apnea–hypopnea index (AHI) and in OSA patients according to the presence or absence of NAFLD. Multivariate regression analysis was used to evaluate the independent risks of NAFLD in OSA patients.

Results

A total of 175 participants were included. The 106 ultrasound-diagnosed NAFLD patients were classified into four groups by AHI. There were no significant differences in triglycerides (TG), serum aminotransferase levels of alanine aminotransferase and aspartate aminotransferase, high-sensitivity C-reactive protein, and homeostasis model assessment of insulin resistance (HOMA-IR) with worsening OSA. In both OSA patients with NAFLD and those without NAFLD, body mass index (BMI), the lowest oxygen saturation (LaSO2), HOMA-IR, and TG were significantly associated. Additionally, BMI, LaSO2, and TG independently predicted the development of NAFLD after adjustments (odds ratio [OR] = 1.562, p = 0.003; OR = 0.960, p = 0.03; OR = 3.410, p < 0.001, respectively).

Conclusions

In nonobese subjects, OSA itself does not appear to induce significant changes in liver enzymes. With reference to lipid metabolism, weight control and OSA-related hypoxemia are key factors in reducing the risk of NAFLD in OSA patients. Additional large-scale, prospective studies are warranted to investigate the impact of OSA on liver injury in nonobese adults.

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Acknowledgments

This work was supported by grant 2014J01414 from the Natural Science Foundation of Fujian Province.

Conflict of interest

Jia-Chao Qi and Jian-Chai Huang contributed equally to the article. All authors certify that they have no financial and personal relationships with other people or organizations that can inappropriately influence our work; there is no professional or other personal interest of any nature or kind in any product, service, and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled.

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Authors and Affiliations

  1. Fujian Provincial Sleep-Disordered Breathing Clinic Center, Laboratory of Respiratory Disease of the Fujian Medical University, Department of Respiratory Medicine, the First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Rd., Taijiang, Fuzhou, 350005, Fujian Province, People’s Republic of China

    Jia-Chao Qi, Jian-Chai Huang, Qi-Chang Lin, Jian-Ming Zhao, Xin Lin, Jie-Feng Huang & Xiao Chen

  2. Department of Respiratory Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59, West Shengli Rd., Xiangcheng, Zhangzhou, 363000, Fujian Province, People’s Republic of China

    Li-Da Chen

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  1. Jia-Chao Qi
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  4. Jian-Ming Zhao
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Correspondence to Qi-Chang Lin.

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Qi, JC., Huang, JC., Lin, QC. et al. Relationship between obstructive sleep apnea and nonalcoholic fatty liver disease in nonobese adults. Sleep Breath 20, 529–535 (2016). https://doi.org/10.1007/s11325-015-1232-9

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  • DOI: https://doi.org/10.1007/s11325-015-1232-9

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