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Sleep-disordered breathing: a new risk factor of suspected fatty liver disease in overweight children and adolescents?

^* Dept of Paediatrics, Antwerp University Hospital, Belgium, ^# Dept of Diabetology, Metabolism and Clinical Nutrition, Antwerp University Hospital, Belgium, ^¶ Dept of Respiratory Medicine, Antwerp University Hospital, Belgium

CORRESPONDENCE: Stijn L. Verhulst, Dept of Paediatrics, University of Antwerp, Wilrijk, Belgium

Sleep-disordered breathing (SDB) in childhood obesity is associated with hyperinsulinemia, dyslipidemia and inflammation and by these mechanisms, SDB could contribute to development of non-alcoholic fatty liver disease. We, therefore, investigated if SDB was an independent predictor of suspected fatty liver disease in a clinical sample of overweight and obese children and adolescents.

Retrospective case study of consecutive overweight or obese children and adolescents attending a paediatric obesity clinic. Suggestive fatty liver disease was defined as a serum alanine aminotransferase >40 U·L^–1 and/or a hyperechoic liver on abdominal ultrasound.

Subjects with suggestive fatty liver disease presented with higher waist circumference, more circulating peripheral leukocytes and a lower % of total sleep time with SaO2 95% than their peers with a normal liver evaluation. Multiple logistic regression (stepwise forward) selected waist circumference (odds ratio = 1.05; 95% confidence interval = 1.00–1.10; p = 0.06) and SaO2nadir (odds ratio = 0.87; 95% confidence interval = 0.76–0.99; p = 0.03) as predictors of suggestive fatty liver disease.

This study suggests an association between the severity of SDB and suspected fatty liver disease in a clinical sample of overweight and obese children and adolescents. We strongly recommend more and carefully designed research on the influence of SDB on the development of fatty liver disease and on the effect of treating sleep apnoea on liver function parameters.