Lung

, Volume 188, Issue 4, pp 301–307

Continuous Positive Airway Pressure Improves Sleep Apnea Associated Fatty Liver

  • Isaac Shpirer
  • Laurian Copel
  • Efrat Broide
  • Arnon Elizur
Article

DOI: 10.1007/s00408-009-9219-6

Cite this article as:
Shpirer, I., Copel, L., Broide, E. et al. Lung (2010) 188: 301. doi:10.1007/s00408-009-9219-6

Abstract

Treatment of sleep apnea can improve liver enzyme abnormalities in patients with nonalcoholic fatty liver disease. However, the effect of continuous positive airway pressure therapy for sleep apnea on liver fat accumulation was not assessed. Liver biopsy is the “gold standard” for determining and quantifying liver fat accumulation; however, obtaining two separate liver biopsies is challenging. We examined, using a newly described computerized tomography method to quantify liver fat accumulation, whether treatment of sleep apnea improves liver steatosis. In a prospective cohort study, patients diagnosed with obstructive sleep apnea, at Assaf Harofeh Medical Center’s sleep laboratory, were identified. Patients completed a questionnaire and underwent blood tests for liver enzymes and lipid profile, and computed tomography scans to determine the liver attenuation index. Patients with liver attenuation index ≤−10 (correlating with histological macrovesicular steatosis ≥30%) were treated with continuous positive airway pressure for 2–3 years. Subsequently, patients underwent repeat blood tests and tomography scans. Of 47 patients who were analyzed, 16 had a low liver attenuation index (≤−10). Patients with moderate–severe sleep apnea had worse liver attenuation index compared with patients with mild sleep apnea despite comparable body mass index and triglycerides levels. Patients who were compliant with 2–3 years of continuous positive airway pressure treatment demonstrated significant improvement in the mean liver attenuation index, whereas noncompliant patients did not. Patients with nonalcoholic fatty-liver disease may benefit from identification and treatment for obstructive sleep apnea because treatment may improve liver steatosis.

Keywords

HepatitisLiver cirrhosisComputed tomographyPositive pressure respiration

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Isaac Shpirer
    • 1
    • 5
    • 6
  • Laurian Copel
    • 2
    • 6
  • Efrat Broide
    • 3
    • 4
    • 6
  • Arnon Elizur
    • 4
    • 5
    • 6
  1. 1.Institute of Pulmonary MedicineAssaf Harofeh Medical CenterZerifinIsrael
  2. 2.Department of RadiologyAssaf Harofeh Medical CenterZerifinIsrael
  3. 3.Institute of Gastroenterology, Liver Diseases and NutritionAssaf Harofeh Medical CenterZerifinIsrael
  4. 4.Department of PediatricsAssaf Harofeh Medical CenterZerifinIsrael
  5. 5.The Sleep LaboratoryAssaf Harofeh Medical CenterZerifinIsrael
  6. 6.Sackler Faculty of MedicineTel Aviv UniversityAvivIsrael