OBESITY AND METABOLIC SYNDROME INCREASE RISK OF NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IN PATIENTS WITH SLEEP APNEA

Abstract

INTRODUCTION
Obstructive sleep apnea (OSA) has been closely associated with non-alcoholic fatty liver disease (NAFLD), with some shared features of metabolic syndrome. We aimed to study the effect of various components of metabolic syndrome on development of NAFLD in OSA patients.

METHODOLOGY
This was a cross-sectional study conducted at UiTM Medical Faculty. 110 subjects between 18 to 65 years of age with confirmed OSA were recruited, with exclusion of patients with Hepatitis B or C, and significant alcohol intake. Anthropometric measurements were taken, and liver ultrasonography performed for diagnosis of NAFLD. Apnea-hypopnea indices (AHI) were categorized as mild AHI≥5-<15, moderate AHI≥15-≤30, and severe AHI>30/hr based on polysomnography.

RESULT
The prevalence of NAFLD within our study population was 81.8% (95%CI: 74.5-89.1) (n=90). Mean weight in the NAFLD group was significantly higher compared to the non NAFLD group (94.77kg±21.85 vs 74.67kg±16.80, p<0.001), with 82.2% of NAFLD group being obese (p<0.001). The prevalence of NAFLD was 81.8% (n=90). Subjects with NAFLD had significantly higher weight compared to those without NAFLD (94.77kg±21.85 vs 74.67kg±16.80, p<0.001). There were statistically significantly higher mean systolic blood pressure, waist circumference,
hip circumference, waist hip ratio and severity of OSA (AHI) among the NAFLD and vs the non NAFLD groups (143.23 mmHg±16.33 vs 129.35 mmHg±19.96 mmHg, p=0.001; 109.44cm±16.26 vs 91.45cm±15.61, p<0.001, 113.11cm±14.58 vs 100.30cm±12.46, p<0.001, and 0.97±0.08 vs 0.91±0.07, p=0.002, mild AHI 24.4%vs70%, moderate AHI 31.2%vs25% and severe AHI 54%vs5%, p<0.001), respectively. Patients with BMI>27.5 had the highest risk of NAFLD (OR: 17.27, CI: 4.18-71.25, p<0.001), followed by hypertension (OR: 4.33, CI: 1.56-12.06, p=0.005), and diabetes (OR: 3.00, CI: 1.01-8.95, p=0.049).

CONCLUSION
This study highlights the increased risk of NAFLD in patients with OSA and components of metabolic syndrome, prompting the need for increased surveillance and modification of risk factors in this group of patients.