Study on the impact of obstructive sleep apnea-hypopnea syndrome on nonalcoholic fatty liver disease in type 2 diabetes mellitus

Objective To investigate the possible mechanism of the relationship between obstructive sleep apnea-hypopnea syndrome (OSA) and nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes mellitus (T2DM) patients. Methods T2DM patients during hospitalized from 2012 to 2014 were retrospectively investigated. Total 212 T2DM patients hospitalized in Department of Endocrinology from 2012 to 2014 were divided into non-OSA simple T2DM group (DM group, n=113) and OSA combined T2DM group (DO group, n=124). These people were also divided into T2DM combined with nonalcoholic fatty liver disease (NAFLD) (NAFLD group, n=183) and without (non-NAFLD group, n=54). The general clinical and metabolism data and the prevalence of NAFLD were compared. The general clinical and OSA data, and metabolism data, and prevalence of OSA in the ones with and without NAFLD were compared. Further correlation analysis was carried out. Results ⑴The body mass index (BMI), fasting c-peptide (FCP), insulin-resistance index (HOMA-C), total cholesterol (TC), triglyceride (TG), white blood cell count (WBC), glutamate pyruvate transaminase (ALT), glutamic-oxalacetic transaminase (AST), glutamyl transpeptidase (GGT), uric acid (UA), and the prevalence of NAFLD were higher in DO group than DM group (P<0.05). ⑵ Linear regression analyze showed BMI, and FCP had positive correlation with apnea hypopnea index (AHI). ⑶ The patients in NAFLD group had lower level of disease time, high density lipoprotein cholesferol (HDL-C), minimum oxyhemoglobin saturation (LPO2), average oxyhemoglobin saturation (MPO2) and higher level of BMI, systolic pressure (SBP), fasting blood glucose (FPG), FCP, glycosylated hemoglobin (HbA1c), HOMA-C, triacylglycerol (TG), cholesterol/high density lipoprotein cholesferol (TC/HDL-C), ALT, GGT, UA, AHI, oxygen decrease index (ODI) and prevalence of OSA than those without NAFLD (P<0.05). ⑷ Multivariable logistic regression analysis showed that BMI, HOMA-C, and AHI were the risk factors of NAFLD in type 2 diabetes mellitus patients. Conclusions OSA could make T2DM suffer more NAFLD. Key words: Sleep apnea syndromes/CO; Diabetes mellitus, type 2/CO; Fatty liver/ET