The association of nonalcoholic steatohepatitis and obstructive sleep apnea.
The association of nonalcoholic steatohepatitis and obstructive sleep apnea.
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DOI：
10.1097/meg.0000000000000973
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发表时间：
2017-12
影响因子：
2.1
通讯作者：
McCullough AJ
中科院分区：
文献类型：
--
作者：
Asfari MM;Niyazi F;Lopez R;Dasarathy S;McCullough AJ
多项研究已报道阻塞性睡眠呼吸暂停（OSA）与肝酶异常之间存在关联。关于OSA与非酒精性脂肪性肝炎（NASH）之间关系的现有文献存在矛盾。因此，我们旨在从一个大型数据库中确定OSA与NASH之间的关系。
利用2012年全国住院患者样本进行了一项横断面研究。我们使用国际疾病分类第9版（ICD - 9）编码确定了诊断为OSA的成年患者（18 - 90岁）。对照组由无OSA出院记录的成年个体组成。NASH的诊断也使用ICD - 9编码确定。使用单变量和多变量逻辑回归计算OSA与NASH之间的关联。
共纳入30712524例住院患者。OSA组包括1490150例患者，而对照组非OSA组有29222374例。OSA组平均年龄为61.8±0.07岁（女性占44.2%），相比之下，非OSA组平均年龄为57.0±0.11岁（女性占60.1%）。与非OSA组相比，OSA组中NASH的患病率显著更高[2%（95%置信区间：1.9，2.1）对0.65%（0.63，0.66），p < 0.001]。在对肥胖、糖尿病、高血压、血脂异常、代谢综合征和查尔森合并症指数进行调整后，OSA患者患NASH的可能性是对照组的3倍[调整后的比值比：3.1（95%置信区间：3.0 - 3.3），p < 0.001]。
在控制其他混杂因素后，与无OSA的患者相比，OSA患者患NASH的可能性是其三倍。这些数据表明，OSA应被视为发生NASH的一个独立危险因素。
The association between obstructive sleep apnea (OSA) and abnormal liver enzymes has been reported in multiple studies. The existing literature regarding the relationship between OSA and nonalcoholic steatohepatitis (NASH) is conflicting. Thus we aimed to determine the relationship between OSA and NASH from a large database. A cross-sectional study was performed using the 2012 Nationwide Inpatient Sample. We identified adult patients (18–90 year) who had a diagnosis of OSA using the International Classification of Diseases ICD-9 codes. The control group was comprised of adult individuals with no discharge records of OSA. NASH diagnosis was also identified using the ICD-9 codes. The association between OSA and NASH was calculated using univariable and multivariable logistic regression. 30,712,524 hospitalizations were included. The OSA group included 1,490,150 patients versus 29,222,374 in the control non-OSA group. The OSA group average age was 61.8±0.07 years (44.2% females) compared to 57.0±0.11 years (60.1% females) in the non-OSA group. NASH prevalence was significantly higher in the OSA group compared to the non-OSA group [2% (95% CI: 1.9, 2.1) versus 0.65% (0.63, 0.66), p<0.001]. After adjusting for obesity, diabetes, hypertension, dyslipidemia, the metabolic syndrome and Charlson comorbidity index, OSA patients were 3 times more likely to have NASH [adjusted OR:3.1 (95% CI: 3.0 – 3.3), p<0.001]. Patients with OSA are three times more likely to have NASH compared to patients without OSA after controlling for other confounders. These data indicate that OSA should be considered as an independent risk factor for developing NASH.