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Association between obstructive sleep apnea and non-alcoholic fatty liver disease in pediatric patients: a
Li-Da Chen1, Meng-Xue Chen2, Gong-Ping Chen2
1Department of Respiratory and Critical Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China.
Insights
Obstructive sleep apnea (OSA) is linked to non-alcoholic fatty liver disease (NAFLD) in children, with elevated liver enzymes and fibrosis. Early screening for NAFLD in pediatric OSA patients is recommended.
Area of Science:
- Pediatric Gastroenterology
- Sleep Medicine
- Hepatology
Background:
- Obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD) have a potential link in children.
- Previous research on this association in the pediatric population is controversial.
Purpose of the Study:
- To investigate the association between OSA and NAFLD in pediatric patients.
- To analyze liver enzyme levels, hepatic inflammation, and fibrosis in children with and without OSA.
Main Methods:
- Systematic literature search of PubMed, Web of Science, and Embase.
- Meta-analysis of nine cross-sectional studies involving 1133 children and adolescents.
- Calculation of pooled standardized mean difference (SMD) and weighted mean difference (WMD).
Main Results:
- OSA was significantly associated with elevated ALT, AST, and NAFLD fibrosis stage.
- No significant association was found between OSA and NAFLD inflammation grade.
- Subgroup analyses confirmed elevated ALT and AST in both mild and severe OSA cases, even after adjusting for confounding factors.
Conclusions:
- OSA is associated with NAFLD in children, indicated by increased liver enzymes and hepatic fibrosis.
- Screening for NAFLD is crucial in pediatric patients diagnosed with obesity-related OSA.
Background:
Some studies have reported a relationship between obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD) in pediatric population. However, this issue remains controversial.
Objectives:
The purpose of the present study was to investigate the association between OSA and NAFLD in pediatric population.
Methods:
We systematically searched PubMed, Web of Science, Embase for eligible studies. The data involving markers of NAFLD including alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatic inflammation, hepatic fibrosis of both OSA group and control group were extracted. Pooled standardised mean difference (SMD) and weighted mean difference (WMD) were appropriately calculated through a fixed or random-effect model.
Results:
Nine cross-sectional studies with 1133 children and adolescents were included. OSA was significantly associated with ALT, AST, and NAFLD fibrosis stage, but not NAFLD inflammation grade. Subgroup analysis indicated that both mild OSA and severe OSA were significantly associated with elevated ALT and AST. Furthermore, in the studies with all main confounding factors (age, gender, and BMI) matched, OSA group had higher ALT and AST levels than control group.
Conclusions:
This meta-analysis suggested that OSA was associated with NAFLD evidenced by elevated liver enzymes and progressive hepatic fibrosis in pediatric population. Screening and monitoring of NAFLD in pediatric patients with obesity-related OSA are necessary.
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