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Obstructive Sleep Apnea Is Associated with Fatty Liver and Abnormal Liver Enzymes: a Meta-analysis

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Abstract

Background

Obstructive sleep apnea (OSA) is associated with the cluster of clinical conditions that comprise the metabolic syndrome, including nonalcoholic fatty liver disease (NAFLD). Our primary purpose was to estimate the effect of OSA on serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Our secondary purpose was to investigate the potential influence of OSA on histological severity of NAFLD to explore whether chronic intermittent hypoxia is associated with inflammation and fibrosis.

Methods

Our literature search identified 11 studies, from which we extracted information about numbers of control subjects and OSA patients, and ALT, AST, and NAFLD.

Results

From a total of 668 OSA patients and 404 controls, we found that the standardized difference in mean values of ALT and AST levels in patients with OSA was significantly different from that in the controls. Meta-regression showed that the association was independent of body mass index and type 2 diabetes. Fatty liver was associated with OSA in five studies with 400 subjects. OSA was significantly associated with liver fibrosis in 208 subjects, but not with lobular inflammation.

Conclusions

Routine assessment of liver enzymes and liver damage should be implemented in OSA patients because they have an increase of 13.3 % of ALT and 4.4 % of AST levels, and a 2.6-fold higher risk of liver fibrosis when they have NAFLD, which is 2.6 times more frequent in OSA patients.

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Acknowledgments

This study was supported in part by grants UBACYT CM04 (Universidad de Buenos Aires) and PICT 2008-1521 and 2010-0441 (Agencia Nacional de Promoción Científica y Tecnológica). SS and CJP belong to Consejo Nacional de Investigaciones Científicas y Tecnicas. SS also belongs to Consejo de Investigación en Salud del Gobierno de la Ciudad Autonóma de Bs. As.

Conflict of Interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Clinical and Molecular Hepatology, Institute of Medical Research A Lanari-IDIM, University of Buenos Aires–National Council of Scientific and Technological Research (CONICET), Ciudad Autónoma de Buenos Aires, Argentina

    Silvia Sookoian

  2. Research Council in Health, Ciudad Autónoma de Buenos Aires, Argentina

    Silvia Sookoian

  3. Department of Molecular Genetics and Biology of Complex Diseases, Institute of Medical Research A Lanari-IDIM, University of Buenos Aires–National Council of Scientific and Technological Research (CONICET), Ciudad Autónoma de Buenos Aires, Argentina

    Carlos J. Pirola

  4. Instituto de Investigaciones Médicas A. Lanari, CONICET, Cambatiente de Malvinas 3150, Buenos Aires, 1427, Argentina

    Silvia Sookoian & Carlos J. Pirola

Authors
  1. Silvia Sookoian
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Corresponding authors

Correspondence to Silvia Sookoian or Carlos J. Pirola.

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Authors’ contributions

CJP and SS designed the study, analyzed and interpreted the data, and prepared and wrote the manuscript. CJP performed the statistical analysis. Both authors read and approved the final manuscript

Appendix

Appendix

Search methods and process of study selection.

Fig. 6
figure 6

MOOSE guidelines for meta-analyses and systematic reviews of observational studies

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Sookoian, S., Pirola, C.J. Obstructive Sleep Apnea Is Associated with Fatty Liver and Abnormal Liver Enzymes: a Meta-analysis. OBES SURG 23, 1815–1825 (2013). https://doi.org/10.1007/s11695-013-0981-4

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