Risk of obstructive sleep apnea with daytime sleepiness is associated with liver damage in non-morbidly obese patients with nonalcoholic fatty liver disease

Edoardo Alessandro Pulixi, Eleonora Tobaldini, Pier Maria Battezzati, Paola D'Ingianna, Vittorio Borroni, Anna Ludovica Fracanzani, Marco Maggioni, Serena Pelusi, Mara Bulgheroni, Massimo Zuin, Silvia Fargion, Nicola Montano, Luca Valenti

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Abstract

Background: A high prevalence of obstructive sleep apnea syndrome (OSAS) has been reported in severely obese patients with nonalcoholic fatty liver disease (NAFLD), but few studies have evaluated OSAS in non-morbidly obese NAFLD patients. Aims: To determine the prevalence of risk for OSAS with or without daytime sleepiness in non-morbidly obese patients with NAFLD and evaluate the association with the severity of liver damage. Methods: We considered 159 consecutive patients with histological NAFLD and body mass index (BMI) 2, and 80 controls without ultrasonographic steatosis matched for age, sex, and BMI. OSAS risk was determined by positivity for Berlin questionnaire (BQ), and daytime sleepiness by the Sleepness Epworth Scale (ESS). Liver damage was evaluated according to the NAFLD activity score. Results: In NAFLD patients, BQ alone was positive in 39 (25%), ESS in 8 (5%), and both in 13 (8%, OSAS with sleepines); p = ns vs. controls without steatosis. In NAFLD patients at risk for OSAS with (but not in those without) sleepiness, we observed a higher prevalence of nonalcoholic steatohepatitis (NASH; 11/13, 85% vs. 72/146, 49%; p = 0.018), and of clinically significant fibrosis (stage>1; 9/13, 69% vs. 39/146, 27%; p = 0.003). At multivariate logistic regression analysis, OSAS with sleepiness was strongly associated with NASH and fibrosis>1 independently of known clinical risk factors such as age, gender, BMI, diabetes, and ALT levels (OR 7.1, 95% c.i. 1.7-51, p = 0.005 and OR 14.0, 95% c.i. 3.5-70, p = 0.0002, respectively). Conclusions: A proportion of NAFLD patients without severe obesity is at risk for OSAS with daytime sleepiness, which is associated with the severity of liver damage independently of body mass and other cofactors.

Original languageEnglish
Article numbere96349
JournalPLoS One
Volume9
Issue number4
DOIs
Publication statusPublished - Apr 24 2014

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sleep apnea
fatty liver
Obstructive Sleep Apnea
Liver
liver
body mass index
Body Mass Index
fibrosis
Berlin
questionnaires
Fibrosis
Non-alcoholic Fatty Liver Disease
Sleep
gender
Morbid Obesity
diabetes
obesity
regression analysis
risk factors
Medical problems

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Risk of obstructive sleep apnea with daytime sleepiness is associated with liver damage in non-morbidly obese patients with nonalcoholic fatty liver disease. / Pulixi, Edoardo Alessandro; Tobaldini, Eleonora; Battezzati, Pier Maria; D'Ingianna, Paola; Borroni, Vittorio; Fracanzani, Anna Ludovica; Maggioni, Marco; Pelusi, Serena; Bulgheroni, Mara; Zuin, Massimo; Fargion, Silvia; Montano, Nicola; Valenti, Luca.

In: PLoS One, Vol. 9, No. 4, e96349, 24.04.2014.

Research output: Contribution to journalArticle

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abstract = "Background: A high prevalence of obstructive sleep apnea syndrome (OSAS) has been reported in severely obese patients with nonalcoholic fatty liver disease (NAFLD), but few studies have evaluated OSAS in non-morbidly obese NAFLD patients. Aims: To determine the prevalence of risk for OSAS with or without daytime sleepiness in non-morbidly obese patients with NAFLD and evaluate the association with the severity of liver damage. Methods: We considered 159 consecutive patients with histological NAFLD and body mass index (BMI) 2, and 80 controls without ultrasonographic steatosis matched for age, sex, and BMI. OSAS risk was determined by positivity for Berlin questionnaire (BQ), and daytime sleepiness by the Sleepness Epworth Scale (ESS). Liver damage was evaluated according to the NAFLD activity score. Results: In NAFLD patients, BQ alone was positive in 39 (25{\%}), ESS in 8 (5{\%}), and both in 13 (8{\%}, OSAS with sleepines); p = ns vs. controls without steatosis. In NAFLD patients at risk for OSAS with (but not in those without) sleepiness, we observed a higher prevalence of nonalcoholic steatohepatitis (NASH; 11/13, 85{\%} vs. 72/146, 49{\%}; p = 0.018), and of clinically significant fibrosis (stage>1; 9/13, 69{\%} vs. 39/146, 27{\%}; p = 0.003). At multivariate logistic regression analysis, OSAS with sleepiness was strongly associated with NASH and fibrosis>1 independently of known clinical risk factors such as age, gender, BMI, diabetes, and ALT levels (OR 7.1, 95{\%} c.i. 1.7-51, p = 0.005 and OR 14.0, 95{\%} c.i. 3.5-70, p = 0.0002, respectively). Conclusions: A proportion of NAFLD patients without severe obesity is at risk for OSAS with daytime sleepiness, which is associated with the severity of liver damage independently of body mass and other cofactors.",
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AU - Pulixi, Edoardo Alessandro

AU - Tobaldini, Eleonora

AU - Battezzati, Pier Maria

AU - D'Ingianna, Paola

AU - Borroni, Vittorio

AU - Fracanzani, Anna Ludovica

AU - Maggioni, Marco

AU - Pelusi, Serena

AU - Bulgheroni, Mara

AU - Zuin, Massimo

AU - Fargion, Silvia

AU - Montano, Nicola

AU - Valenti, Luca

PY - 2014/4/24

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N2 - Background: A high prevalence of obstructive sleep apnea syndrome (OSAS) has been reported in severely obese patients with nonalcoholic fatty liver disease (NAFLD), but few studies have evaluated OSAS in non-morbidly obese NAFLD patients. Aims: To determine the prevalence of risk for OSAS with or without daytime sleepiness in non-morbidly obese patients with NAFLD and evaluate the association with the severity of liver damage. Methods: We considered 159 consecutive patients with histological NAFLD and body mass index (BMI) 2, and 80 controls without ultrasonographic steatosis matched for age, sex, and BMI. OSAS risk was determined by positivity for Berlin questionnaire (BQ), and daytime sleepiness by the Sleepness Epworth Scale (ESS). Liver damage was evaluated according to the NAFLD activity score. Results: In NAFLD patients, BQ alone was positive in 39 (25%), ESS in 8 (5%), and both in 13 (8%, OSAS with sleepines); p = ns vs. controls without steatosis. In NAFLD patients at risk for OSAS with (but not in those without) sleepiness, we observed a higher prevalence of nonalcoholic steatohepatitis (NASH; 11/13, 85% vs. 72/146, 49%; p = 0.018), and of clinically significant fibrosis (stage>1; 9/13, 69% vs. 39/146, 27%; p = 0.003). At multivariate logistic regression analysis, OSAS with sleepiness was strongly associated with NASH and fibrosis>1 independently of known clinical risk factors such as age, gender, BMI, diabetes, and ALT levels (OR 7.1, 95% c.i. 1.7-51, p = 0.005 and OR 14.0, 95% c.i. 3.5-70, p = 0.0002, respectively). Conclusions: A proportion of NAFLD patients without severe obesity is at risk for OSAS with daytime sleepiness, which is associated with the severity of liver damage independently of body mass and other cofactors.

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