Introduction: To promote optimal health and well-being, adults aged 18-60 years are recommended to sleep at least 7 hours each night. Sleep disruption has evolved with industrialism and has been associated with metabolic diseases, such as obesity and diabetes in murine models. Almost 90% of patients with nonalcoholic fatty liver disease (NAFLD) have more than one feature of metabolic syndrome. Moreover, sleep disruption can interrupt the circadian rhythm and thus the body metabolism. Therefore, it can be speculated that sleep-related problems may trigger several pathophysiologic processes associated with NAFLD.
Aim: We hypothesized an association between sleep duration, steatosis, and advanced fibrosis.
Methods: Using the NHANES database, we identified all patients aged 18 and older from 2017 to March 2020 pre-pandemic surveys. The presence of fatty liver was determined using vibration-controlled transient elastography (VCTE) ultrasonographic findings. Sleep duration was grouped by short sleep duration (≤7 hours) and normal sleep duration ( >7 hours). Linear regression models were used to examine the relationship between continuous CAP score and sleep duration, after adjusting for potential confounders.
Results: Cohort characteristics are displayed on table 1. A total of 15,560 patients were examined. The mean age of the population was 47 (± 16) years. A greater proportion of patients were white (62%) and female (51%). Mean kPa and CAP were 6 kPa and 264 dB/m, respectably. On simple linear regression short sleep duration was significantly associated with hepatic steatosis (β = [8.4], p = [< 0.001]). Likewise, on multivariable linear regression after adjusting for age and body mass index (BMI), short sleep duration was significant associated with hepatic steatosis (β = [4.0], p = [0.013]). However, after adding sex to the model this association was no longer significant (β = [2.1], p = [0.152]). A relationship was not seen between sleep duration and hepatic fibrosis on unadjusted analysis or when controlling for the same variables described above.
Discussion: Overall, FibroScan® data in NHANES 2017-2020 support a positive association between short sleep duration and hepatic steatosis independently of metabolic factors such as BMI. Prospective studies are required to confirm this association.
