Estimation of the prevalence of obstructive sleep apnea in non alcoholic fatty liver disease

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Published Sep 3, 2018
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Vol. 96 No. 4 (2018): Issue Apr 2018

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Hayfa Romdhane
Service de Gastro-entérologie A. Hôpital la Rabta. Tunis
Shema Ayadi
Myriam Cheikh
Bochra Bouchabou
Houda Ben Nejma
Rym Ennaifer
Service de Gastro-entérologie Hôpital H. Thameur Tunis

Abstract

Introduction:
The prevalence of non alcoholic fatty liver disease is increasing in parallel with the epidemic of obesity and metabolic syndrome. Recent data have shown frequent association between non alcoholic fatty liver disease (NAFLD) and obstructive sleep apnea.
The aim of our study was to estimate the prevalence of sleep disorders, to search an obstructive sleep apnea syndrome by conducting a ventilator polygraphy and to search the particularities of obstructive sleep apnea when its exists, in patients with NAFLD.
Methods:
A prospective study, conducted over a period of 6 months, including patients followed for non-alcoholic fatty liver disease. We performed in all patients a Berlin questionnaire that assesses the risk of obstructive sleep apnea syndrome, an Epworth score that estimates the degree of daytime sleepiness and a ventilator polygraphy.
Results:
We collected 37 patients. The mean age was 50,41±13,7 years. The sex ratio (M/F) was 0,42. Type 2 diabetes mellitus, arterial hypertension or dyslipidemia were recorded respectively in 37,8%, 40,5% and  37,8% of cases. Snoring was noted in 75,7%  of cases and excessive daytime sleepiness in 34,2% of cases. Obesity was observed in 73% and metabolic syndrome in 43,2% of cases. The Berlin Questionnaire was positive in 64,9% of cases. The average score of Epworth scale was 9,22±4,02 and 43,2% of patients had a score> 10. Ventilatorypolygraphy was positive in 13 cases (35,1%) with a mean AHI of  7,02±10,08.In these patients, obstructive sleep apnea was mild, moderate and severe in respectively 61,5%, 15,4% and 23,1% of cases. In univariate analysis, subjects with positive ventilator polygraphy had a significantly higher waist circumference (118,00 versus 109,58, p=0,05). Arterial hypertension was significantly associated with increased daytime sleepiness (p=0,018). In multivariate analysis, the only independent variable associated with excessive daytime sleepiness was arterial hypertension (OR=5,33 p=0,021).
Conclusion:
In our study, the prevalence of obstructive sleep apnea syndrome is high in patients with non alcoholic fatty liver disease. The only independent variable associated with excessive daytime sleepiness was arterial hypertension.

Keywords:

Fatty liver disease, obstructive sleep apnea, metabolic syndrome, ventilator polygraphy

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References

  1. Chalsasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and managment of non alcoholic fatty liver disease : Practice Guidelines by the American Association for the Study of Liver Diseases, American College of Gastroenterology and the American Gastroenterological Association. Hepatology. 2012;55:2005-23.
  2. Vuppalanchi R, Chalasani N. Non-alcoholic liver disease and non-alcoholic steatohepatitis. Hepatology.2009 ;49 :306-17.
  3. Yu JH, Ahn JH, Yoo HJ, Seo JA, Kim SG, Choi KM et al. Obstructive sleep apnea with excessive daytime sleepiness is associated with non-alcoholic fatty liver disease regardless of visceral fat. Korean J Intern Med. 2015 ;30 :846-55
  4. Kohler M, Stradling JR. Mechanisms of vascular damage in obstructive sleep apnea. Nat Rev Cardiol. 2010 ;7 :677-85.
  5. Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: Summary of an AASLD Single Topic Conference. Hepatology.2003;37:1202-19.
  6. Edmison J, McCullough AJ. Pathogenesis of Non-Alcoholic Steatohepatitis : Human Data. Clin Liver Dis. 2007;11:75-104.
  7. Valls C, Iannaccone R, Alba E, Murakami T, Hori M, Passariello R et al. Fat in the liver : diagnosis and characterization. EurRadiol. 2006 ;16 :2292-308
  8. Zimmet P, Magliano D, Matsuzawa Y, Albert G, Shaw J. The metaboloicsyndrome : A global Public health problem and a new definition. J atherosclerThromb.2005 ;12 :295-300.
  9. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131:485-91
  10. Johns MW. A new method for measuring daytime sleepiness : The Epworth sleepiness scale. Sleep. 1991 ;14 :540-5.
  11. Johns MW. Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and epwoth sleepiness scale : failure of the MSLT as a gold standard. J Sleep Res.2000;9:5-11.
  12. Gharibeh T, Mehra R. Obstructive sleep apnea syndrome: natural history, diagnosis and emerging treatment options. Nat Sci Sleep. 2010;2:233-55.
  13. Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. ClinGastroenterolHepatol. 2011;9:524-30.
  14. Vernon G, Baranova A, Younossi ZM. Systematic review : the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohépatitis in type 2 diabetes mellitus. J GastroenterolHepatol. 2004;19:854-8.
  15. Simon S, Collop N. Latest advances in sleep medicine: obstructive sleep apnea. Chest. 2012;142:1645-51.
  16. El Fadili S, Zaghba N, Benjelloun H, Yassine N. L'apport de la polygraphie ventilatoire dans le diagnostic du syndrome d'apnées obstructives du sommeil. Rev Mal Respir. 2016 ;33 :262
  17. Lemarié E, Valeyre D, Housset B, Godard P. Sleepapnea syndrome : clinical practice guidelines .Rev Mal Resp. 2010;27:804-5.
  18. Silva GE, Vana KD, Godwin JL, Sherril DL, Quan SF. Identification of patients with sleep disordered breathing: Comparing the Four-Variable Screening Tool, STOP, STOP-Bang and Epwoth Sleepiness Scales. J Clin Sleep Med. 2011;7:467-72.
  19. Saleh ABM, Ahmad MA, Awadalla NJ. Development of Arabic version of Berlin questionnaire to identify obstructive sleep apnea at risk patients. Ann Thorac Med. 2011;6:212-6.
  20. Sagaspe P, Leger D, Taillard J, Bayon V, Chaumet G, Philip P. Might the Berlin Sleep Questionnaire applied to bed partners be used to screen sleep apneic patients. Sleep Med. 2010;11:479-83.
  21. Savransky V, Nanayakkara A, Li J, Bevans S, Smith PL, Rodriguez A et al. Chronic intermittent hypoxia induces atherosclerosis. Am J RespirCrit Care Med. 2007 ;175 :1290-7
  22. Drager LF, Li J, Reike C, Bevans-Fonti S, Jun JC, Polotsky VY. Intermittent hypoxia exacerbates metabolic effets of diet-induced obesity. Obesity (Silver Spring).2011;19:2167-74.
  23. Del Ben M, Fabiani M, Loffredo L, Polimeri L, Carnevale R, Baratta F et al. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment. BMC Pulm Med. 2012 ;12 :36
  24. Culver C, Sundqvist A, Mudie S, Melvin A, Xirodimas D, Rocha S. Mechanism of hypoxia-induced NF-kB. Mol Cell Biol. 2010;30:4901-21
  25. Sing H, Pollock R, Uhanova J, Kryger M, Hawkins K, Minuk GY. Symptoms of obstructive sleep apnea in patients with non-alcoholic fatty liver disease.DigDisSci. 2005;50:2338-43.
  26. Lin Q-C, Chen L-D, Chen G-P, Zhao J-M, Chen X, Huang J-F et al. Association between nocturnal hypoxia and liver injury in the setting of non alcoholic fatty liver disease.Sleep Breath. 2015 ;19 :273-80.
  27. Turkay C, Ozol D, Kasapoglu B, Kiebas I, Yildirim Z, Yigitoglu R. Influence of obstructive sleep apnea on fatty liver disease: Role of chronic intermittent hypoxia. Respir Care. 2012 ;57 :244-9.
  28. Chou T-C, Liang W-M, Wang C-B, Wu T-N, Hang L-W. Obstructive sleep apnea is associated with liver disease : a population-based cohort study. Sleep Med. 2015;16:955-60.
  29. Pulixi EA, Tobaldini E, Battezati PM, D'Ingianna P, Borroni V, Fracanzani AL et al. Risk of obstructive sleep apnea with daytine sleepiness is associated with liverr damage in non-morbidly obese patients with nonalcoholic fatty liver disease. PLoS ONE.2014 ;9 :E96349.
  30. Corey KE, Misdraji J, Gelrud L, King LY, Zheng H, Malhotra A et al. Obstructive sleep apnea is associated with non alcoholicsteatohepatitis and advanced liver histology. Dig Dis Sci. 2015 ;60 :2523-8.
  31. Shpirer I, Copel L, Broide E, Elizur A. Continuous positive airway pressure improves sleep apnea associated fatty liver. Lung.2010;188:301-7.