Effects of Sleep Quality on Non-alcoholic Fatty Liver Disease: a Cross-sectional Survey

Overview

Journal BMJ Open

Specialty General Medicine

Date 2020 Oct 30

PMID 33122322

Citations 11

Authors

Atsushi Takahashi

Yukio Anzai

Masahito Kuroda

Masae Kokubun

Yuichiro Kondo

Takashi Ogata

Masashi Fujita

Manabu Hayashi

Hiromichi Imaizumi

Kazumichi Abe

Nobuo Tanji

Hiromasa Ohira

Affiliations

Soon will be listed here.

Abstract

Background: The effects of sleep quality on the risk of developing non-alcoholic fatty liver disease (NAFLD) remain uncertain. The purpose of this study was to clarify the association between sleep quality and NAFLD.

Methods: The data of 4828 participants who underwent health check-ups at four hospitals were analysed. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), which comprised seven elements scored from 0 to 3. The global PSQI score and the score for each element were compared between NAFLD and non-NAFLD groups separately by sex. Logistic regression analysis was performed to determine the association between NAFLD and each PSQI score.

Results: In both men and women, the mean PSQI score for sleep medication use was significantly higher in non-NAFLD than in NAFLD. With regard to sleep medication use in men, the OR (95% CI) for NAFLD was lower with a score of 3 (OR 0.60, 95% CI 0.38-0.95) than with a score of 0 on multivariate logistic regression analysis adjusted for age, smoking habits and physical activity. The OR for NAFLD based on daytime dysfunction was also higher with a score of 3 than with a score of 0 in both men (OR 2.82, 95% CI 1.39-5.75) and women (OR 2.08, 95% CI 1.10-3.92). After adjustment for body mass index, the sleep latency scores in men and daytime dysfunction in women were associated with NAFLD.

Conclusion: Sleep quality was associated with NAFLD, and there were sex differences.

Citing Articles

Association of occupational noise exposure and shift work with non-alcoholic fatty liver disease: a cross-sectional study of male workers in the Chinese automobile manufacturing industry.

Zhang J, Zhang Y, Qiu C, Zeng W, Ruan Y, Gao Y BMJ Open. 2025; 15(3):e085753.

PMID: 40074255 PMC: 11904356. DOI: 10.1136/bmjopen-2024-085753.

Association between sleep duration and risk of nonalcoholic fatty liver disease: A systematic review and meta-analysis.

Pirahesh K, Zarrinnia A, Nikniaz L, Nikniaz Z Prev Med Rep. 2025; 50:102968.

PMID: 39897736 PMC: 11783128. DOI: 10.1016/j.pmedr.2025.102968.

Interaction between the systemic immune-inflammation index and trouble sleeping in nonalcoholic fatty liver disease: a cross-sectional study of the NHANES 2005-2018 data.

Yang X, Zhuo S, Zhuang H, Fang T J Health Popul Nutr. 2024; 43(1):175.

PMID: 39478637 PMC: 11526651. DOI: 10.1186/s41043-024-00670-9.

Non-alcoholic fatty liver disease and sleep disorders.

Bu L, Xiong C, Zhong J, Xiong Y, Li D, Hong F World J Hepatol. 2024; 16(3):304-315.

PMID: 38577533 PMC: 10989311. DOI: 10.4254/wjh.v16.i3.304.

Evaluation of Hepatic Steatosis and Fibrosis Using Transient Elastography in Patients With Obstructive Sleep Apnea.

Parchani A, Gupta R, Kant R, Saini L, Gupta R J Clin Exp Hepatol. 2024; 14(2):101289.

PMID: 38544762 PMC: 10964064. DOI: 10.1016/j.jceh.2023.09.010.

References

Bernsmeier C, Weisskopf D, Pflueger M, Mosimann J, Campana B, Terracciano L . Sleep Disruption and Daytime Sleepiness Correlating with Disease Severity and Insulin Resistance in Non-Alcoholic Fatty Liver Disease: A Comparison with Healthy Controls. PLoS One. 2015; 10(11):e0143293. PMC: 4648512. DOI: 10.1371/journal.pone.0143293. View

Buysse D, Reynolds 3rd C, Monk T, BERMAN S, Kupfer D . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4. View

Da Silva J . Sex hormones and glucocorticoids: interactions with the immune system. Ann N Y Acad Sci. 1999; 876:102-17; discussion 117-8. DOI: 10.1111/j.1749-6632.1999.tb07628.x. View

Littman A, Vitiello M, Foster-Schubert K, Ulrich C, Tworoger S, Potter J . Sleep, ghrelin, leptin and changes in body weight during a 1-year moderate-intensity physical activity intervention. Int J Obes (Lond). 2006; 31(3):466-75. DOI: 10.1038/sj.ijo.0803438. View

Huedo-Medina T, Kirsch I, Middlemass J, Klonizakis M, Siriwardena A . Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ. 2012; 345:e8343. PMC: 3544552. DOI: 10.1136/bmj.e8343. View

Balbo M, Leproult R, Van Cauter E . Impact of sleep and its disturbances on hypothalamo-pituitary-adrenal axis activity. Int J Endocrinol. 2010; 2010:759234. PMC: 2902103. DOI: 10.1155/2010/759234. View

Wijarnpreecha K, Thongprayoon C, Panjawatanan P, Ungprasert P . Short sleep duration and risk of nonalcoholic fatty liver disease: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2016; 31(11):1802-1807. DOI: 10.1111/jgh.13391. View

Sauchelli S, Jimenez-Murcia S, Fernandez-Garcia J, Garrido-Sanchez L, Tinahones F, Casanueva F . Interaction Between Orexin-A and Sleep Quality in Females in Extreme Weight Conditions. Eur Eat Disord Rev. 2016; 24(6):510-517. DOI: 10.1002/erv.2484. View

Toi N, Inaba M, Kurajoh M, Morioka T, Hayashi N, Hirota T . Improvement of glycemic control by treatment for insomnia with suvorexant in type 2 diabetes mellitus. J Clin Transl Endocrinol. 2019; 15:37-44. PMC: 6306692. DOI: 10.1016/j.jcte.2018.12.006. View

10.

Tsuneki H, Wada T, Sasaoka T . Role of orexin in the regulation of glucose homeostasis. Acta Physiol (Oxf). 2009; 198(3):335-48. DOI: 10.1111/j.1748-1716.2009.02008.x. View

11.

Garfield V, Joshi R, Garcia-Hernandez J, Tillin T, Chaturvedi N . The relationship between sleep quality and all-cause, CVD and cancer mortality: the Southall and Brent REvisited study (SABRE). Sleep Med. 2019; 60:230-235. PMC: 6626293. DOI: 10.1016/j.sleep.2019.03.012. View

12.

Wong V, Chan W, Chitturi S, Chawla Y, Dan Y, Duseja A . Asia-Pacific Working Party on Non-alcoholic Fatty Liver Disease guidelines 2017-Part 1: Definition, risk factors and assessment. J Gastroenterol Hepatol. 2017; 33(1):70-85. DOI: 10.1111/jgh.13857. View

13.

Aron-Wisnewsky J, Clement K, Pepin J . Nonalcoholic fatty liver disease and obstructive sleep apnea. Metabolism. 2016; 65(8):1124-35. DOI: 10.1016/j.metabol.2016.05.004. View

14.

Imaizumi H, Takahashi A, Tanji N, Abe K, Sato Y, Anzai Y . The Association between Sleep Duration and Non-Alcoholic Fatty Liver Disease among Japanese Men and Women. Obes Facts. 2015; 8(4):234-42. PMC: 5644852. DOI: 10.1159/000436997. View

15.

Marin-Alejandre B, Abete I, Cantero I, Monreal J, Elorz M, Herrero J . The Metabolic and Hepatic Impact of Two Personalized Dietary Strategies in Subjects with Obesity and Nonalcoholic Fatty Liver Disease: The Fatty Liver in Obesity (FLiO) Randomized Controlled Trial. Nutrients. 2019; 11(10). PMC: 6836315. DOI: 10.3390/nu11102543. View

16.

Younossi Z, Tacke F, Arrese M, Sharma B, Mostafa I, Bugianesi E . Global Perspectives on Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis. Hepatology. 2018; 69(6):2672-2682. DOI: 10.1002/hep.30251. View

17.

Musso G, Cassader M, Rosina F, Gambino R . Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials. Diabetologia. 2012; 55(4):885-904. DOI: 10.1007/s00125-011-2446-4. View

18.

Kishi T, Matsunaga S, Iwata N . Suvorexant for Primary Insomnia: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. PLoS One. 2015; 10(8):e0136910. PMC: 4552781. DOI: 10.1371/journal.pone.0136910. View

19.

Farrell G, Chitturi S, Lau G, Sollano J . Guidelines for the assessment and management of non-alcoholic fatty liver disease in the Asia-Pacific region: executive summary. J Gastroenterol Hepatol. 2007; 22(6):775-7. DOI: 10.1111/j.1440-1746.2007.05002.x. View

20.

Kanji S, Mera A, Hutton B, Burry L, Rosenberg E, MacDonald E . Pharmacological interventions to improve sleep in hospitalised adults: a systematic review. BMJ Open. 2016; 6(7):e012108. PMC: 4986185. DOI: 10.1136/bmjopen-2016-012108. View