Korean J Intern Med.  2015 Nov;30(6):846-855. 10.3904/kjim.2015.30.6.846.

Obstructive sleep apnea with excessive daytime sleepiness is associated with non-alcoholic fatty liver disease regardless of visceral fat

• Yu JH
• Ahn JH
• Yoo HJ
• Seo JA
• Kim SG
• Choi KM
• Baik SH
• Choi DS
• Shin C
• Kim NH

• KMID: 2381589
• DOI: http://doi.org/10.3904/kjim.2015.30.6.846

Abstract

BACKGROUND/AIMS
Obstructive sleep apnea (OSA) is associated with an increased risk of obesity and non-alcoholic fatty liver disease (NAFLD), but it remains unclear whether the risk of NAFLD is independently related to OSA regardless of visceral obesity. Thus, the aim of the present study was to examine whether OSA alone or in combination with excessive daytime sleepiness (EDS) or short sleep duration was associated with NAFLD independent of visceral fat in Korean adults.
METHODS
A total of 621 participants were selected from the Korean Genome and Epidemiology Study (KoGES). The abdominal visceral fat area (VFA) and hepatic fat components of the participants were assessed using computed tomography scans and they were then categorized into four groups depending on the presence of OSA and EDS.
RESULTS
The proportions of NAFLD were 21.1%, 18.5%, 32.4%, and 46.7% in participants without OSA/EDS, with only EDS, with only OSA, and with both OSA and EDS, respectively. A combination of OSA and EDS increased the odds ratio (OR) for developing NAFLD (OR, 2.75; 95% confidence interval [CI], 1.21 to 6.28) compared to those without OSA/EDS, and this association remained significant (OR, 2.38; 95% CI, 1.01 to 5.59) even after adjusting for VFA. In short sleepers (< 5 hours) with OSA, the adjusted OR for NAFLD was 2.50 (95% CI, 1.08 to 5.75) compared to those sleeping longer than 5 hours without OSA.
CONCLUSIONS
In the present study, OSA was closely associated with NAFLD in Korean adults. This association was particularly strong in those with EDS or short sleep duration regardless of VFA.

Keyword

Sleep apnea, obstructive; Fatty liver; Intra-abdominal fat

MeSH Terms

*Adiposity
Aged
Asian Continental Ancestry Group
Chi-Square Distribution
Disorders of Excessive Somnolence/diagnosis/*epidemiology/physiopathology
Female
Humans
Intra-Abdominal Fat/*physiopathology
Logistic Models
Male
Middle Aged
Multivariate Analysis
Non-alcoholic Fatty Liver Disease/diagnosis/*epidemiology/physiopathology
Obesity, Abdominal/diagnosis/*epidemiology/physiopathology
Odds Ratio
Republic of Korea/epidemiology
Risk Factors
*Sleep
Sleep Apnea, Obstructive/diagnosis/*epidemiology/physiopathology