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Obstructive Sleep Apnea Is Associated with Nonalcoholic Steatohepatitis and Advanced Liver Histology

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Abstract

Background and Aims

Nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA) are growing in prevalence in the USA. Existing data on the relationship between OSA and NAFLD are conflicting and limited by the use of various histologic definitions of nonalcoholic steatohepatitis (NASH). Using a robust definition of NASH in a large, well-characterized cohort, we sought to evaluate whether OSA was associated with NASH and advanced fibrosis.

Methods

Two hundred and thirteen subjects undergoing weight loss surgery were queried for OSA and then underwent liver biopsy. NASH was defined, as recommended by the American Association for the Study of Liver Disease, by the presence of all of the following: >5 % macrovesicular steatosis, lobular inflammation, and hepatocyte ballooning. NAFLD activity score (NAS) was also determined for each subject.

Results

Subjects with OSA had significantly higher alanine and aspartate aminotransferase levels than subjects without OSA (ALT 54.1 vs. 37.7 U/L, P = 0.0007; AST 31.7 vs. 20.5 U/L, P = 0.0007). OSA was associated with the presence of NASH, and this remained significant after adjusting for age, gender, race, and diabetes mellitus (P = 0.03 OR 2.01; 95 %, 1.05–3.87). Steatosis grade, lobular inflammation grade, NAS score, and fibrosis stage were all significantly associated with the presence of OSA and remained so after adjustment.

Conclusions

OSA is associated with elevated aminotransferase levels, the presence of NASH, and advanced NASH histology. Further studies are needed to evaluate the impact of OSA treatment on NASH.

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Abbreviations

NAFLD:

Nonalcoholic fatty liver disease

OSA:

Obstructive sleep apnea

NASH:

Nonalcoholic steatohepatitis

NAS:

NAFLD activity score

WLS:

Weight loss surgery

BMI:

Body Mass Index

AASLD:

American Association for the Study of Liver Disease

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Acknowledgments

NIH K23 DK099422 (KEC); K24 DK078772 (RTC); K24 HL 093218 (AM).

Conflict of interest

The authors have no conflict to report.

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Authors and Affiliations

  1. Gastrointestinal Unit, Massachusetts General Hospital, Warren 1007, 55 Fruit Street, Boston, MA, 02114, USA

    Kathleen E. Corey, Lindsay Y. King & Raymond T. Chung

  2. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA

    Joseph Misdraji

  3. Department of Internal Medicine, Bon Secours Richmond Health System, Richmond, VA, USA

    Lou Gelrud

  4. MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA

    Hui Zheng

  5. Department of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA, USA

    Atul Malhotra

  6. Harvard Medical School, Boston, MA, USA

    Kathleen E. Corey, Joseph Misdraji, Hui Zheng & Raymond T. Chung

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  1. Kathleen E. Corey
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  2. Joseph Misdraji
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  3. Lou Gelrud
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Correspondence to Kathleen E. Corey.

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Corey, K.E., Misdraji, J., Gelrud, L. et al. Obstructive Sleep Apnea Is Associated with Nonalcoholic Steatohepatitis and Advanced Liver Histology. Dig Dis Sci 60, 2523–2528 (2015). https://doi.org/10.1007/s10620-015-3650-8

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  • DOI: https://doi.org/10.1007/s10620-015-3650-8

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