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. 2020 Jun 9;10(1):9267.
doi: 10.1038/s41598-020-66208-1.

Self-reported snoring is associated with nonalcoholic fatty liver disease

Hui Wang  1 , Qian Gao  1 , Simin He  1 , Yanping Bao  2 , Hongwei Sun  1 , Lingxian Meng  1 , Jie Liang  1 , Chenming Sun  3 , Shuohua Chen  4 , Liying Cao  5 , Wei Huang  6 , Yanmin Zhang  7 , Jianjun Huang  8 , Shouling Wu  9 , Tong Wang  10
Affiliations

Self-reported snoring is associated with nonalcoholic fatty liver disease

Hui Wang et al. Sci Rep. .

Abstract

Although nonalcoholic fatty liver disease (NAFLD) is associated with obstructive sleep apnea syndrome (OSAS), studies on the direct relationship between NAFLD and snoring, an early symptom of OSAS, are limited. We evaluated whether snorers had higher risk of developing NAFLD. The study was performed using data of the Tongmei study (cross-sectional survey, 2,153 adults) and Kailuan study (ongoing prospective cohort, 19,587 adults). In both studies, NAFLD was diagnosed using ultrasound; snoring frequency was determined at baseline and classified as none, occasional (1 or 2 times/week), or habitual (≥3 times/week). Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals were estimated using logistic and Cox models, respectively. During 10 years' follow-up in Kailuan, 4,576 individuals with new-onset NAFLD were identified at least twice. After adjusting confounders including physical activity, perceived salt intake, body mass index (BMI), and metabolic syndrome (MetS), multivariate-adjusted ORs and HRs for NAFLD comparing habitual snorers to non-snorers were 1.72 (1.25-2.37) and 1.29 (1.16-1.43), respectively. These associations were greater among lean participants (BMI < 24) and similar across other subgroups (sex, age, MetS, hypertension). Snoring was independently and positively associated with higher prevalence and incidence of NAFLD, indicating that habitual snoring is a useful predictor of NAFLD, particularly in lean individuals.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow of the selection of study populations, included in Tongmei and Kailuan. NAFLD, nonalcoholic fatty liver disease; OSAS, obstructive sleep apnea syndrome.
Figure 2
Figure 2
Stratified odds ratio (OR) (95% confidence interval (CI)) of snoring on nonalcoholic fatty liver disease according to (a) age, sex, obesity, body mass index(BMI) and metabolic syndrome (MetS), and (b) MetS components in the Tongmei population, adjusted for age (<45 or ≥45 years), sex, marital status (single, married, divorced/widowed/separated), education (illiterate/primary, junior high school, senior high school or college, bachelor’s degree or higher), income (≤4000, >4000–6000, >6000 RMB), workplace (underground/surface), occupation type (mental labour/light physical labour/heavy physical labour), current tobacco smoking (yes, no), perceived salt intake (low, medium, high), degree of International physical activity questionnaire (IPAQ) (low, moderate, high), degree of sedentary behaviour (low, moderate, high), total energy intake per day (low, moderate, high), elevated serum liver enzymes (no/yes), obesity (normal, central, overweight, both), and MetS (no/yes). Yellow indicates habitual snorers compared with non-snorers; blue indicates occasional snorers compared with non-snorers. Significant P values are shown for interaction on a multiplicative scale.
Figure 3
Figure 3
Stratified relative risk (RR) (95% confidence interval (CI)) of snoring on nonalcoholic fatty liver disease according to (a) age, sex, obesity, body mass index (BMI) and metabolic syndrome (MetS), and (b) MetS components in the Kailuan cohort, adjusted for age (<45, 45–<55, 55–<65, ≥65 years), sex, marital status (single, married, divorced/widowed/separated), education (illiterate/primary, junior high school, senior high school, college or higher), income (<600, 600–800, 800–1000, >1000 RMB), workplace (underground/surface), occupation type (mental labour/physical labour), current tobacco smoking (yes, no), perceived salt intake (low, medium, high), physical activity (no, occasional, always), sedentary duration (<4, 4–8, >8 hours per day), elevated ALT (>40 U/L), obesity (normal, simple central, simple overweight, both), elevated SUA (>357 μmol/ L for women and >420 μmol/ L for men), CRP (<1, 1–3, >3 mg/L), and MetS (no/yes). Yellow indicates habitual snorers compared with non-snorers; blue indicates occasional snorers compared with non-snorers. Significant P values are shown for interaction on a multiplicative scale.
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