Analysis Of Clinical Characteristics In Patients With Obstructive Sleep Apnea And Nonalcoholic Fatty Liver Disease

Background and ObjectiveNonalcoholic fatty liver disease(NAFLD)was a metabolic stress-induced liver injury closely related to insulin resistance(IR)and genetic susceptibility.It was characterized by fatty degeneration and fatty storage of liver parenchymal cells.The incidence of NAFLD patients has increased significantly with the increase of obese people.NAFLD was replacing hepatitis B as the main cause of chronic liver disease in my country.Obstructive sleep apnea(OSA)refers to sleep apnea and hypoventilation caused by upper airway collapse and obstruction during sleep,accompanied by snoring,sleep structure disorders,frequent blood oxygen saturation decline,daytime sleepiness and other symptoms.It was a disease that has a high incidence,seriously affects life and life-threatening.It was an independent risk factor for cardiovascular and cerebrovascular diseases such as coronary atherosclerotic heart disease,cor pulmonale,hypertension,and stroke.It can also damage digestion,nerves,blood,endocrine and genitourinary systems.As the relationship between OSA and NAFLD was getting closer and closer,it was found that OSA can lead to the development of NAFLD.OSA and NAFLD were widespread in the population,and their impact on human health was gradually expanding,gradually increasing the number of medical treatment and economic burden of patients.This article retrospectively analyzed the characteristics of general informations,clinical indicators and polysomnography(PSG)related indicators of OSA and NAFLD patients to explore the risk factors of OSA,NAFLD and OSA combined with NAFLD,and clarify the impact of OSA on NAFLD.To provide reference for clinical prevention and intervention of OSA,NAFLD and OSA combined with NAFLD.Material and MethodsSelected from June 2018 to December 2020,570 inpatients who underwent PSG examination at the Sleep Diagnosis and Treatment Center of the First Affiliated Hospital of Dalian Medical University due to sleep disorders,hypertension and other problems for the first time.Collect patient general informations including gender,age,diabetes,hypertension,waist circumference,Epworth Sleepiness Scale(ESS),systolic blood pressure(SBP),diastolic blood pressure(DBP),body fat rate(BFR),visceral fat index(VAI),Fatty Liver Disease Index(FLD),Lipid Accumulation Index(LAP),Body Mass Index(BMI),clinical indicators including triglycerides(TG),total cholesterol(TC),high density lipoprotein(HDL),low density Lipoprotein(LDL),aspartate aminotransferase(AST),alanine aminotransferase(ALT),blood sugar,PSG related indicators including apnea hypopnea index(AHI),minimum blood oxygen saturation(LSaO2),Oxygen reduction index(ODI),mean blood oxygen saturation(MSa O2),the time that oxygen saturation is below 90%(CT90),total apnea time,liver ultrasound.SPSS 20.0 statistical software was used for analysis.Numerical variables conforming to normal distribution were expressed as mean±standard deviation(`x±s),independent sample t test was used for comparison between two groups,and one-way analysis of variance was used for comparison between multiple groups.The numerical variables of skewed distribution were represented by the median(Q25-Q75),the Mann-Whitney U test was used for comparison between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups.Categorical variables were expressed as rate(%),and the χ2 test was used for comparison between groups.The correlation between variables was analyzed by Pearson or Spearman correlation analysis.Binary Logistic regression analysis was performed with OSA,NAFLD and OSA combined with NAFLD as outcome variables,P < 0.05,the difference was considered statistically significant,the ROC curve was further drawn to find the best cut point of risk factors.Results1.Comparison of general informations,clinical indicators,and PSG-related indicators between OSA and non-OSA patients: There was no significant difference in age between the two groups(P=0.782),differences of proportion of male patients(73.88% vs 45.79%),the proportion of diabetic patients(24.24%)vs 11.21%),the proportion of hypertension patients(72.71% vs 61.68%),the proportion of NAFLD patients(71.29% vs 40.19%),waist circumference,ESS score,SBP,DBP,BFR,VAI,FLD,LAP,BMI,TG,TC,HDL,LDL,AST,ALT,blood glucose,AHI,LSaO2,ODI,MSa O2,CT90,and total apnea time were statistical significance(all P <0.05)2.Correlation analysis of general informations and clinical indicators of all patients with AHI: there was no correlation between age,SBP,TC and AHI(all P>0.05),waist circumference,DBP,BFR,FLD,LAP,VAI,BMI,TG,LDL,ALT,AST,blood glucose was positively correlated with AHI(r=0.509,0.161,0.486,0.520,0.491,0.377,0.534,0.344,0.105,0.390,0.291,0.283,all P <0.05),HDL was negatively correlated with AHI(r=-0.178,P<0.001)3.Risk factor analysis of OSA: Binary Logistic regression analysis was performed with OSA outcome as the dependent variable and gender,diabetes,hypertension,NAFLD,SBP,DBP,waist circumference,BFR,FLD,LAP,VAI,BMI,TG,TC,HDL,LDL,AST,ALT,blood glucose as the independent variables,the results showed that DBP,BFR,FLD,BMI,HDL,AST,ALT,blood glucose were risk factors for OSA [OR and 95%CI were respectively 1.052(1.014-1.092),1.210(1.058-1.383),2.038(1.350-3.075),0.444(0.275-0.717),0.104(0.140-0.800),1.200(1.095-1.315),0.936(0.896-0.979),1.806(1.222-2.669),all P < 0.05].further draw the ROC curve,AUC of DBP,BFR,FLD,BMI,HDL,AST,ALT were respectively 0.615,0.781,0.829,0.793,0.678,0.725,0.788,0.698,and the best cut-off point values for predicting OSA occurrence were respectively 84.5mm Hg,38.45%,33.37,26.95kg/m~2,1.185mmol/L,16.5IU/L,23.5IU/L,4.985 mmol/L.4.General informations,clinical indicators and PSG related indicators of different degrees of OSA patients comparison: There was no significant difference in age,VAI,TG,TC,HDL,LDL between the three groups of patients with mild,moderate,and severe OSA(all P>0.05).differences of Waist circumference,ESS score,SBP,DBP,BFR,FLD,LAP,BMI,ALT,AST,blood glucose,AHI,LSaO2,ODI,MSa O2,CT90,total apnea time were statistical significance among the three groups(all P values <0.05).5.The proportion of patients with different degrees of OSA complicated with NAFLD: the proportion of patients with normal,mild,moderate and severe OSA complicated with NAFLD was respectively 40.19%,58.82%,73.50% and 81.94%,and differences were statistically significant in the proportion of patients with NAFLD among the four groups(χ2=54.811,P < 0.05).6.Comparison of general informations,clinical indicators and PSG related indicators between NAFLD and non-NAFLD patients: differences were not statistically significant in gender and ESS score between the two groups(all P> 0.05),differences were statistically significant in ratio of diabetes patients(26.30% vs 12.90%),ratio of hypertension patients(76.88% vs 58.60%),age,waist circumference,SBP,DBP,BFR,VAI,FLD,LAP,BMI,TG,TC,HDL,LDL,AST,ALT,blood glucose,AHI,LSaO2,ODI,MSa O2,CT90 and total time of apnea(all P < 0.05).7.Risk factor analysis of NAFLD: Binary Logistic regression analysis was performed with NAFLD outcome as the dependent variable and diabetes,hypertension,age,SBP,DBP,waist circumference,BFR,FLD,LAP,VAI,BMI,TG,TC,HDL,LDL,AST,ALT,blood glucose,AHI,LSaO2,ODI,MSa O2,CT90 and total time of apnea as the independent variables,the results showed that BMI,HDL,MSa O2,FLD and hypertension were risk factors for NAFLD [OR and 95%CI were respectively 0.732(0.547-0.979),0.213(0.056-0.810),1.162(1.010-1.336),1.474(1.128-1.925),2.195(1.213-3.972),all P < 0.05].further draw the ROC curve,AUC of BMI,HDL,MSa O2,FLD were respectively 0.748,0.621,0.573,0.801,and the best cut-off point values for predicting NAFLD occurrence were respectively 26.55kg/m~2,1.125mmol/L,95.50%,31.96.8.Comparison of general informations,clinical indicators and PSG related indicators between OSA and OSA combined with NAFLD: There were no statistically significant differences in gender,ESS score,AST,MSa O2 and CT90 between the two groups(all P> 0.05),differences were statistically significant in ratio of diabetes patients(17.21% vs 27.06%),ratio of hypertension patients(62.30% vs 76.90%),age,waist circumference,SBP,DBP,BFR,VAI,FLD,LAP,BMI,TG,TC,HDL,LDL,ALT,blood glucose,AHI,LSaO2,ODI and total time of apnea(all P < 0.05).9.Comparison of general informations,clinical indicators and PSG related indicators of patients with different degrees of OSA complicated with NAFLD: there were no statistically differences in age,SBP,DBP,VAI,LAP,TG,TC,HDL,LDL,AST,ALT and blood glucose among the three groups(all P > 0.05),differences were statistically significant in waist circumference,ESS score,BFR,FLD,BMI,AHI,LSaO2,ODI,MSa O2,CT90 and total apnea time among the three groups(all P < 0.05).10.Risk factor analysis of OSA combined with NAFLD: Binary Logistic regression analysis was performed with OSA combined with NAFLD outcome as the dependent variable and age,diabetes,hypertension,SBP,DBP,waist circumference,BFR,FLD,LAP,VAI,BMI,TG,TC,HDL,LDL,ALT,blood glucose,AHI,LSaO2,ODI and total time of apnea as the independent variables,the results showed that BMI,FLD and hypertension were risk factors for OSA combined with NAFLD [OR and95%CI were respectively 0.741(0.560-0.981),1.423(1.123-1.803),0.516(0.273-0.978);all P< 0.05].further draw the ROC curve,AUC of BMI and FLD were respectively0.720,0.768(all P < 0.05),and the best cut-off point values for predicting OSA combined with NAFLD occurrence were respectively 27.65kg/m~2,33.4.Conclusions1.OSA increases the risk of NAFLD.2.Obesity,FLD and hypertension are risk factors for OSA combined with NAFLD.3.It is predicted that by controlling body weight,blood glucose,blood pressure,correcting lipid metabolism disorders,and improving OSA hypoxia,the risk of NAFLD and OSA combined with NAFLD can be reduced.