睡眠时长和睡眠质量与非酒精性脂肪性肝病发病风险关系的Meta分析

Relationship between Sleep Duration or Sleep Quality and Non-alcoholic Fatty Liver Disease:a Meta-analysis

背景非酒精性脂肪性肝病(NAFLD)是目前全世界范围最为流行的肝脏疾病,并且NAFLD很可能成为终末期肝病最主要的原因。但遗憾的是,NAFLD对健康的危害尚未能引起足够重视。尽管有研究尝试阐述睡眠与NAFLD的关系,但结果存在很大的差异。目的评价睡眠时长和睡眠质量与NAFLD发病风险的关系。方法计算机检索PubMed、EMBase、中国知网(CNKI)中关于睡眠时长和睡眠质量与NAFLD发病风险关系的文献,检索时限为建库至2020年2月。由2位研究者根据文献纳入与排除标准独立筛选文献、提取资料并使用纽卡斯尔-渥太华量表(NOS)进行质量评价。采用Stata 16.0软件进行Meta分析。结果共纳入16篇文献。Meta分析结果显示,短睡眠时间(≤6 h)增加18%的NAFLD发病风险〔OR=1.18,95%CI(1.04,1.33),P=0.01〕,亚组分析结果显示,睡眠时间<5 h增加28%的NAFLD发病风险〔OR=1.28,95%CI(1.11,1.48),P<0.01〕。长睡眠时间(>6 h)与NAFLD发病风险无关〔OR=0.98,95%CI(0.78,1.23),P=0.87〕,亚组分析结果显示,睡眠时间>8 h增加22%的NAFLD发病风险〔OR=1.22,95%CI(1.08,1.36),P<0.01〕,男性的长睡眠时间(>6 h)降低了17%的NAFLD发病风险〔OR=0.83,95%CI(0.74,0.94),P<0.01〕。睡眠质量差与NAFLD发病风险无关〔OR=1.06,95%CI(0.94,1.20),P=0.36〕,亚组分析结果显示,女性睡眠质量差增加29%的NAFLD发病风险〔OR=1.29,95%CI(1.12,1.48),P<0.01〕。结论短睡眠时间(≤6 h)可能增加NAFLD发病风险,且睡眠时间越短NAFLD发病风险可能越高;睡眠时间>8 h可能增加NAFLD发病风险;长睡眠时间(>6 h)可能使男性NAFLD发病风险降低;女性睡眠质量差可能增加NAFLD发病风险。未来仍需要更多大型的队列研究以及相关试验进一步验证本Meta分析结果。

Background Non-alcoholic fatty liver disease(NAFLD) is the most prevalent liver disease worldwide,which is likely to become the leading cause of end-stage liver disease.Unfortunately,the potential risks of NAFLD have not received sufficient attention.Although several studies have attempted to elucidate the relationship between sleep and NAFLD,their results vary widely.Objective To evaluate the relationship between sleep duration or sleep quality and NAFLD.Methods Databases of PubMed,EMBase,and CNKI were searched from inception to February 2020 to collect studies about the relationship between sleep duration or sleep quality and NAFLD.Two researchers independently screened the literature based on literature inclusion and exclusion criteria,extracted the data,and used the Newcastle-Ottawa Scale for quality evaluation.The Meta-analysis was performed using Stata 16.0.Results A total of 16 articles were included.The meta-analysis results show that:short sleep duration (≤ 6 h) increased the risk of NAFLD by 18%〔OR=1.18,95%CI(1.04,1.33),P=0.01〕.Further subgroup analysis showed that the risk of NAFLD was increased by 28%〔OR=1.28,95%CI(1.11,1.48),P<0.01〕 when sleep duration was <5 h.Long sleep duration(>6 h) had no effect on the incidence of NAFLD〔OR=0.98,95%CI(0.78,1.23),P=0.87〕.Further subgroup analysis found that the risk of NAFLD was increased by 22%〔OR=1.22,95%CI(1.08,1.36),P<0.01〕 when sleep duration > 8 h.But long sleep duration(>6 h) reduced men’s risk of NAFLD by 17%〔OR=0.83,95%CI(0.74,0.94),P<0.01〕.Poor sleep quality had no effect on the incidence of NAFLD〔OR=1.06,95%CI(0.94,1.20),P=0.36〕.But further subgroup analysis found that poor sleep quality increased the risk of NAFLD by 29% in females〔OR=1.29,95%CI(1.12,1.48),P<0.01〕.Conclusion Short sleep duration (≤6 h) may increase the risk of NAFLD,and the shorter sleep duration,the higher the risk of NAFLD.The risk of NAFLD may increase when sleep duration is >8 h.But long sleep duration(>6 h) may reduce men’s risk of NAFLD.Poor sleep quality may increase the risk of NAFLD in females.More largescale cohort studies and related trials are needed to further validate our results.