Sleep and Breathing

, Volume 23, Issue 1, pp 171–178 | Cite as

Non-alcoholic fatty liver disease is an independent risk factor for inflammation in obstructive sleep apnea syndrome in obese Asian Indians

  • Surya Prakash Bhatt
  • Randeep GuleriaEmail author
  • Naval K. Vikram
  • A. K. Gupta
Sleep Breathing Physiology and Disorders • Original Article



Obstructive sleep apnea (OSA) has been estimated to affect 4–11% of the population and causes systemic inflammation which leads to metabolic syndrome (MS). Non-alcoholic fatty liver disease (NAFLD) is also associated with MS whether NAFLD is an additional risk factor for the systemic inflammation that occurs in OSA is unclear.


In this study, we aimed to analyze the association of OSA and NAFLD with MS and systemic inflammation in Asian Indians.


Total 240 (132 males and 108 females) overweight/obese subjects [body mass index (BMI > 23 kg/m2)] were recruited; of these, 124 subjects had OSA with NAFLD, 47 had OSA without NAFLD, 44 did not have OSA but had NAFLD and 25 had neither OSA nor without NAFLD. Severity of NAFLD was based on abdomen ultrasound and of OSA on overnight polysomnography. Clinical examinations, anthropometry, body composition, metabolic parameters, and inflammatory biomarkers were recorded.


Serum levels of leptin, macrophage migration inhibitory factor (MIF), interleukin-6 (IL-6), high sensitive C-reactive protein (Hs-CRP), and tumor necrosis factor alpha (TNF-α) were significantly higher, and adiponectin levels were significantly lower in OSA with NAFLD subjects. Prevalence of MS was significantly increased in OSA and NAFLD subjects (p = 0.001). There was a strong association and correlation between leptin, IL-6, Hs-CRP, MIF, and TNF-α in OSA and NAFLD subjects. Multivariate logistic regression showed that OSA was positively associated with the NAFLD [odds ratio (OR), (95% confidence interval (CL) 3.12 (2.58–7.72), (P = 0.002)].


NAFLD is an additional risk factor in OSA subject which contributes to systemic inflammation in Asian Indians.


Obstructive sleep apnea Non-alcoholic fatty liver disease Insulin resistance Apnea hypopnea index Metabolic syndrome 



The authors acknowledge the contribution of Mr. Kirti Pratap who performed many of the biochemical investigations. Finally, the cooperation of the subjects who took part in the study is greatly appreciated.

Financial disclosure

Funding for this study was provided through the Ministry of Science and Technology, Department of Science and Technology (Ref: SR/SO/HS-0146/2010), Government of India. The sponsors had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11325_2018_1678_MOESM1_ESM.docx (60 kb)
ESM 1 (DOCX 59 kb)


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Pulmonary Medicine and Sleep DisordersAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of MedicineAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of RadiologyAll India Institute of Medical SciencesNew DelhiIndia

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