Association between Sleep Disturbances and Liver Status in Obese Subjects with Nonalcoholic Fatty Liver Disease: A Comparison with Healthy Controls

Abstract

The relevance of sleep patterns in the onset or evolution of nonalcoholic fatty liver disease (NAFLD) is still poorly understood. Our aim was to investigate the association between sleep characteristics and hepatic status indicators in obese people with NAFLD compared to normal weight non-NAFLD controls. Ninety-four overweight or obese patients with NAFLD and 40 non-NAFLD normal weight controls assessed by abdominal ultrasonography were enrolled. Hepatic status evaluation considered liver stiffness determined by Acoustic Radiation Force Impulse elastography (ARFI) and transaminases. Additionally, anthropometric measurements, clinical characteristics, and biochemical profiles were determined. Sleep features were evaluated using the Pittsburgh Sleep Quality Index (PSQI). Hepatic status parameters, anthropometric measurements, and clinical and biochemical markers differed significantly in NAFLD subjects compared to controls, as well as sleep efficiency, sleep disturbance score, and sleep quality score. In the NAFLD group, a higher prevalence of short sleep duration (p = 0.005) and poor sleep quality (p = 0.041) were found. Multivariate-adjusted odds ratio (95% confidence interval) for NAFLD considering sleep disturbance was 1.59 (1.11–2.28). Regression models that included either sleep disturbance or sleep quality predicted up to 20.3% and 20.4% of the variability of liver stiffness, respectively, and after adjusting for potential confounders. Current findings suggest that sleep disruption may be contributing to the pathogenesis of NAFLD as well as the alteration of the liver may be affecting sleep patterns. Consequently, sleep characteristics may be added to the list of modifiable behaviors to consider in health promotion strategies and in the prevention and management of NAFLD.

<p>Association of Serum Fibroblast Growth Factor 23 Levels with the Presence and Severity of Hepatic Steatosis Is Independent of Sleep Duration in Patients with Diabetes</p>

“…23 Epidemiological studies revealed the association between sleep duration and NAFLD, of which the results, nevertheless, did not reach a consensus. [22][23][24][25] A meta-analysis found an increased risk of NAFLD among individuals with short sleep duration. 22 A study from China revealed the correlation between short sleep duration and an increased risk of prevalent NAFLD among middle-aged and elderly Chinese populations.…”

“…Spanish researchers discovered that sleep disruption might contribute to the pathogenesis of NAFLD, and the alteration of the liver, in turn, might influence sleep patterns. 24 However, Kim et al provided evidence supporting the relationship between longer sleep duration and incidence of NAFLD. 25 Consistent with most of the previous studies, the present study uncovered that hepatic steatosis was attenuated in individuals with longer sleep duration.…”

Relationship Between Coffee Consumption, Sleep Duration and Smoking Status With Elastographic Parameters of Liver Steatosis and Fibrosis; Controlled Attenuation Parameter and Liver Stiffness Measurements

“…Nowadays, we know that T2DM, obesity, hypertension, and dyslipidemia as the MetS components are the main risk factors for NAFLD. On the other hand, NAFLD development is also influenced by multiple features, such as demographic, genetic, and environmental determinants (23). Therefore, the investigation of the possible influence of other putative factors is becoming in interest of clinicians who manage NAFLD patients.…”

Insufficient nocturnal sleep was associated with a higher risk of fibrosis in patients with diabetes with metabolic associated fatty liver disease

“… 25 Sleep disturbance or low sleep quality was also related to increased liver stiffness in patients with NAFLD, which was consistent with our findings, whereas optimal sleep (defined as sleep duration ⩾7 h and ⩽9 h/day) was found to be protective in reducing insulin resistance and liver stiffness. 8 , 26 …”

“… 7 , 8 Sleep disruption contributes to the pathogenesis of hepatic steatosis, and short sleep duration is positively associated with liver stiffness. 8 Furthermore, a study reported that insufficient sleep had negative effects on metabolic disorders including diabetes mellitus (DM), obesity, insulin resistance, and metabolic syndrome. 7 However, the relation between sleeping disorder and progression of MAFLD remains unknown.…”