Obstructive sleep apnea is an important predictor of hepatic fibrosis in patients with nonalcoholic fatty liver disease in a tertiary care center
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The association of obstructive sleep apnea (OSA) with nonalcoholic fatty liver disease (NAFLD) has only been studied in selected subgroups such as the morbidly obese. We aimed to determine the prevalence and effect of OSA on NAFLD and vice versa in unselected patients attending the outpatient department.
OSA was diagnosed by polysomnography, done in patients having symptoms of OSA, in patients with NAFLD attending the liver clinic. Polysomnography-proven patients with OSA attending the chest clinic were evaluated for NAFLD by ultrasonography. Anthropometry, liver function tests, metabolic syndrome evaluation and transient elastography were performed in all patients.
Three (3 %; 95 % CI 1.03–8.45 %) out of 100 patients with NAFLD (mean age 41 ± 11 years) had symptomatic OSA. Of 23 patients with OSA (mean age 46 ± 12 years,), 3 (13 %) had mild, 5 (22 %) moderate and 15 (65 %) severe OSA. Twenty-one (91.3 %; 95 % CI 73.2–97.6 %) patients with OSA had NAFLD, while raised hepatic transaminase levels were seen in seven (30.4 %; 95 % CI 15.6–50.9 %). Body mass index (OR 1.21, 95 % CI 1.02–1.44) and male gender (OR 4.79, 95 % CI 1.12–20.48) were significant independent predictors of OSA in NAFLD. The apnea-hypopnea index (OR 1.084, 95 % CI 1.002–1.172), a marker of OSA severity, was the only significant independent predictor of significant fibrosis in patients with NAFLD.
Prevalence of symptomatic OSA in patients with NAFLD is low and is predicted by male gender and obesity. Prevalence of NAFLD in patients with OSA is very high. Significant hepatic fibrosis in patients with NAFLD is predicted by OSA independent of obesity and metabolic syndrome.
KeywordsObstructive sleep apnea Nonalcoholic fatty liver disease Metabolic syndrome Liver fibrosis Obesity Transient elastography
American Academy of Sleep Medicine
Area under the receiver-operating curve
Bioelectrical impedance analyzer
Body mass index
Excessive daytime somnolence
Epworth sleepiness scale
Homeostasis model assessment of insulin resistance
Liver stiffness measurement
National cholesterol education program-adult treatment panel
Nonalcoholic fatty liver disease
NAFLD activity score
Obstructive sleep apnea
Obstructive sleep apnea syndrome
- Sat <90 %
Percentage of total sleep time spent in hypoxia
Compliance with Ethical Requirements
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study. Written informed consent was taken from all participants, and the study was approved by the institute’s ethics committee. This article does not contain any studies with animal subjects.
Conflict of interest
Swastik Agrawal, Ajay Duseja, Ashutosh Aggarwal, Ashim Das, Manu Mehta, Radha K Dhiman and Yogesh Chawla declare that they have no conflict of interest.
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