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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 12
Dec.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(12): 2854-2860

Association between metabolic associated fatty liver disease and sleep disorders

DOI: 10.3969/j.issn.1001-5256.2021.12.024

  • Department of Gastroenterology, Postgraduate Training Base of Jinzhou Medical University & Panjin Central Hospital, Panjin, Liaoning 124000, China

Research funding:

Natural Science Foundation of Liaoning Province (JYTQN2020031)

  • Received Date: 2021-04-22
  • Accepted Date: 2021-06-18
  • Published Date: 2021-12-20
    Abstract
  •   Objective  To investigate the association between metabolic associated fatty liver disease (MAFLD) and sleep disorders.  Methods  A total of 222 patients with MALFD who were admitted to Panjin Central Hospital from February 2020 to February 2021 and 270 healthy individuals were enrolled as subjects. According to age, the patients with MALFD were divided into youth group with 93 patients, middle-aged group with 76 patients, and elderly group with 53 patients; according to controlled attenuation parameter (CAP) of liver fat, the patients were divided into non-steatosis group with 23 patients, mild steatosis group with 85 patients, moderate steatosis group with 76 patients, and severe steatosis group with 38 patients; according to liver stiffness measurement (LSM), the patients were divided into non-progressive fibrosis group with 124 patients and progressive fibrosis group with 98 patients. Related data were collected, including general information such as age and sex and laboratory markers such as routine blood test results and biochemistry, and after informed consent was obtained, three sleep scales, i.e., Pittsburgh Sleep Quality Index (PSQI) scale, Epworth Sleepiness Scale (ESS), and Morningness-Eveningness Questionnaire (MEQ), were completed independently. The MAFLD group and the healthy control group were compared in terms of general information and laboratory markers to investigate the association between MAFLD and sleep disorders under different grouping criteria. The chi-square test was used for comparison of categorical data between two groups; the t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test was used for comparison between the groups of MAFLD patients with different ages and degrees of hepatic steatosis and pairwise comparison within each group. A logistic regression analysis was used to investigate the independent risk factors for MAFLD, and a Spearman correlation analysis was used to investigate the correlation of hepatic steatosis degree and fibrosis degree with sleep quality, somnolence, and circadian rhythm.  Results  There were significant differences in age, sex, hypertension, diabetes, and smoking between the MAFLD group and the healthy control group (all P < 0.05). Compared with the healthy control group, the MAFLD group had significantly higher hemoglobin, white blood cell count, lymphocyte percentage, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, serum uric acid, low-density lipoprotein, total bilirubin, total cholesterol, triglyceride, and body mass index and significantly lower albumin and high-density lipoprotein (all P < 0.05). Compared with the healthy control group, the MAFLD group had significantly higher PSQI score (t=35.529, P < 0.001) and ESS score (t=24.647, P < 0.001) and significantly lower MEQ score (t=-22.416, P < 0.001) and sleep time (t=-8.660, P < 0.001). With the increase in age in the MAFLD group, hepatic steatosis degree, liver fibrosis degree, and PSQI score showed an increasing trend, and pairwise comparison of each scoring factor between groups showed statistical significance (all P < 0.05). Compared with the healthy control group, the MAFLD group had a significantly higher proportion of patients with definitely evening type, moderately evening type, or intermediate type and a significantly lower proportion of patients with moderately morning type or definitely morning type (all P < 0.05), and MEQ score tended to decrease with the increase in hepatic steatosis degree and liver fibrosis degree, with significant differences between two groups (all P < 0.05). The multivariate logistic regression analysis showed that overweight/obesity (odds ratio [OR]=3.166, P=0.027), diabetes (OR=6.811, P=0.045), increase in white blood cell count (OR=2.301, P < 0.001), increase in lymphocyte percentage (OR=1.316, P=0.002), poor sleep quality (OR=8.493, P < 0.001), a high degree of somnolence (OR=5.420, P < 0.001), and circadian rhythm disturbance (OR=3.805, P < 0.001) were risk factors for MAFLD. The Spearman correlation analysis showed that in the MAFLD group, hepatic steatosis degree was positively correlated with PSQI score (r=0.444, P < 0.001) and ESS score (r=0.339, P < 0.001) and was negatively correlated with MEQ score (r=-0.195, P=0.004), and liver fibrosis degree was positively correlated with PSQI score (r=0.518, P < 0.001) and ESS score (r=0.373, P < 0.001) and was negatively correlated with MEQ score (r=-0.250, P=0.004).  Conclusion  Compared with healthy individuals, the patients with MAFLD often have sleep disorders, and the severity of sleep disorders increases with age, hepatic steatosis degree, and liver fibrosis degree. Obesity, diabetes, and sleep disorders are risk factors for the onset of MAFLD.

     

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    • References(22)
  • [1]
    LIN SC, FENG G, LIU JL, et al. From nonalcoholic fatty liver disease to metabolic fatty liver disease: An analysis based on disease heterogeneity[J]. J Clin Hepatol, 2020, 36(11): 2597-2600. DOI: 10.3969/j.issn.1001-5256.2020.11.045.

    林思岑, 冯巩, 刘军林, 等. 从非酒精性脂肪性肝病到代谢性脂肪性肝病——基于疾病异质性角度的分析[J]. 临床肝胆病杂志, 2020, 36(11): 2597-2600. DOI: 10.3969/j.issn.1001-5256.2020.11.045.
    [2]
    ESLAM M, NEWSOME PN, SARIN SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement[J]. J Hepatol, 2020, 73(1): 202-209. DOI: 10.1016/j.jhep.2020.03.039.
    [3]
    JARVIS H, CRAIG D, BARKER R, et al. Metabolic risk factors and incident advanced liver disease in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis of population-based observational studies[J]. PLoS Med, 2020, 17(4): e1003100. DOI: 10.1371/journal.pmed.1003100.
    [4]
    MIR HM, STEPANOVA M, AFENDY H, et al. Association of sleep disorders with nonalcoholic fatty liver disease (NAFLD): A population-based study[J]. J Clin Exp Hepatol, 2013, 3(3): 181-185. DOI: 10.1016/j.jceh.2013.06.004.
    [5]
    KIM JH, JUNG DH, KWON YJ, et al. The impact of the sleep duration on NAFLD score in Korean middle-aged adults: A community-based cohort study[J]. Sleep Med, 2019, 57: 144-150. DOI: 10.1016/j.sleep.2019.02.012.
    [6]
    TARGHER G. Concordance between MAFLD and NAFLD diagnostic criteria in 'real-world' data[J]. Liver Int, 2020, 40(11): 2879-2880. DOI: 10.1111/liv.14623.
    [7]
    XUE R, FAN JG. Brief introduction of an international expert consensus statement: A new definition of metabolic associated fatty liver disease[J]. J Clin Hepatol, 2020, 36(6): 1224-1227. DOI: 10.3969/j.issn.1001-5256.2020.06.007.

    薛芮, 范建高. 代谢相关脂肪性肝病新定义的国际专家共识简介[J]. 临床肝胆病杂志, 2020, 36(6): 1224-1227. DOI: 10.3969/j.issn.1001-5256.2020.06.007.
    [8]
    LAUDISIO A, GIOVANNINI S, FINAMORE P, et al. Metabolic syndrome is associated with better quality of sleep in the oldest old: Results from the "Mugello Study"[J]. Diabetol Metab Syndr, 2020, 12: 46. DOI: 10.1186/s13098-020-00554-y.
    [9]
    JANSSEN KC, PHILLIPSON S, O'CONNOR J, et al. Validation of the epworth sleepiness scale for children and adolescents using rasch analysis[J]. Sleep Med, 2017, 33: 30-35. DOI: 10.1016/j.sleep.2017.01.014.
    [10]
    KANAGARAJAN K, GOU K, ANTINORA C, et al. Morningness-eveningness questionnaire in bipolar disorder[J]. Psychiatry Res, 2018, 262: 102-107. DOI: 10.1016/j.psychres.2018.02.004.
    [11]
    ZENOVIA S, STANCIU C, SFARTI C, et al. Vibration-controlled transient elastography and controlled attenuation parameter for the diagnosis of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease[J]. Diagnostics (Basel), 2021, 11(5): 787. DOI: 10.3390/diagnostics11050787.
    [12]
    Chinese Foundation for Hepatitis Prevention and Control, Chinese Society of Infectious Disease, Chinese Society of Hepatology, et al. Consensus on clinical application of transient elastography detecting liver fibrosis: A 2018 update[J]. Chin Hepatol, 2019, 27(3): 182-191. DOI: 10.3760/cma.j.issn.1007-3418.2019.03.004.

    中国肝炎防治基金会, 中华医学会感染病学分会, 中华医学会肝病学分会, 等. 瞬时弹性成像技术诊断肝纤维化专家共识(2018年更新版)[J]. 中华肝脏病杂志, 2019, 27(3): 182-191. DOI: 10.3760/cma.j.issn.1007-3418.2019.03.004.
    [13]
    ESTES C, ANSTEE QM, ARIAS-LOSTE MT, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030[J]. J Hepatol, 2018, 69(4): 896-904. DOI: 10.1016/j.jhep.2018.05.036.
    [14]
    BAYOUMI A, GRØNBÆK H, GEORGE J, et al. The epigenetic drug discovery landscape for metabolic-associated fatty liver disease[J]. Trends Genet, 2020, 36(6): 429-441. DOI: 10.1016/j.tig.2020.03.003.
    [15]
    RYU S, CHANG Y, KIM SG, et al. Serum uric acid levels predict incident nonalcoholic fatty liver disease in healthy Korean men[J]. Metabolism, 2011, 60(6): 860-866. DOI: 10.1016/j.metabol.2010.08.005.
    [16]
    GAULD C, LOPEZ R, GEOFFROY PA, et al. A systematic analysis of ICSD-3 diagnostic criteria and proposal for further structured iteration[J]. Sleep Med Rev, 2021, 58: 101439. DOI: 10.1016/j.smrv.2021.101439.
    [17]
    WONG WS, FIELDING R. Prevalence of insomnia among Chinese adults in Hong Kong: A population-based study[J]. J Sleep Res, 2011, 20(1 Pt 1): 117-126. DOI: 10.1111/j.1365-2869.2010.00822.x.
    [18]
    WIJARNPREECHA K, THONGPRAYOON C, PANJAWATANAN P, et al. Insomnia and risk of nonalcoholic fatty liver disease: A systematic review and meta-analysis[J]. J Postgrad Med, 2017, 63(4): 226-231. DOI: 10.4103/jpgm.JPGM_140_17.
    [19]
    LI H, GUO M, AN Z, et al. Prevalence and risk factors of metabolic associated fatty liver disease in Xinxiang, China[J]. Int J Environ Res Public Health, 2020, 17(6): 1818 -1830. DOI: 10.3390/ijerph17061818.
    [20]
    TROVATO FM, MARTINES GF, BRISCHETTO D, et al. Fatty liver disease and lifestyle in youngsters: Diet, food intake frequency, exercise, sleep shortage and fashion[J]. Liver Int, 2016, 36(3): 427-433. DOI: 10.1111/liv.12957.
    [21]
    DULAI PS, SINGH S, PATEL J, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis[J]. Hepatology, 2017, 65(5): 1557-1565. DOI: 10.1002/hep.29085.
    [22]
    WONG GL. Update of liver fibrosis and steatosis with transient elastography (Fibroscan)[J]. Gastroenterol Rep (Oxf), 2013, 1(1): 19-26. DOI: 10.1093/gastro/got007.
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