Estudo da prevalência de doença hepática gordurosa não alcoólica em portadores de síndrome da apneia obstrutiva do sono e a influência da obesidade nesse contexto.

Abstract

Recent literature studies show a close correlation between obstructive sleep apnea syndrome (OSAS) and non-alcoholic fatty liver disease (NAFLD). The worldwide epidemic of obesity, an important risk factor for both, makes it difficult to interpret the hypotheses of cause and effect relationship between them. As the research progresses, some outcomes have demonstrated the possibility of OSAS as an independent risk factor for liver injury. This study aimed to study the prevalence of NAFLD in OSAS carriers and to verify the influence of obesity in this context. This is an observational, cross-sectional, predominantly descriptive and retrospective epidemiological study conducted in the period from February to July, 2018. It was explored the database of 167 patients, referred from November 2015 to December 2016, to the reference outpatient clinic in sleep medicine at Hospital Universitário Alcides Carneiro – Paraíba. The evaluation of each participant includes: Berlin Questionnaire as a selection criterion, monitoring by type III polysomnography, peripheral blood collection for laboratory tests and performance of hepatic ultrasound. The apnea and hypopnea index categorized the severity of OSAS, and the imaging findings classified the severity of NAFLD. Among the 167 individuals, 98 (58.7%) were NAFLD, being that 43 (43.9%) of them were obese and 55 (56.1%) were non-obese. There was a strong correlation between these subgroups and the prevalence of NAFLD, with p < 0.001 in both analyzes. The mean age was 52.51 years (± 11.66 SD), with 57 (58.2%) female patients and 41 (41.8%) male patients. The body mass index (BMI) had an average of 30.47 kg/m² (± 3.93 SD). The apnea and hypopnea index of the obese was 18 (± 16.4 SD) events/hour and the non-obese index was 13.2 (± 10.8 SD), with p = 0.26. There was no association between altered BMI and the severity of OSAS and NAFLD. In this scenario, the knowledge of overweight as a determining but reversible element is fundamental. On the other hand, in this sample, there was a higher prevalence of non-obese patients with NAFLD, considered high when compared to other studies that used the same diagnostic methods. Therefore, an association between OSAS and NAFLD, especially when independent of obesity, should involve different mechanisms that are still unknown. The understanding of the relationship between these pathologies makes it possible to expand the strategies in health care to improve regard for the population.