Apnoeic–hypopnoeic episodes during obstructive sleep apnoea are associated with histological nonalcoholic steatohepatitis

  1. Poonam Mishra1,
  2. Clarke Nugent1,2,
  3. Arian Afendy1,2,
  4. Chunhong Bai2,
  5. Priya Bhatia1,
  6. Mariam Afendy1,
  7. Yun Fang2,
  8. Hazem Elariny2,
  9. Zachary Goodman3,
  10. Zobair M. Younossi1,2

Article first published online: 18 JUL 2008

DOI: 10.1111/j.1478-3231.2008.01822.x

Issue

Liver International

Liver International

Volume 28, Issue 8, pages 1080–1086, September 2008

Additional Information

How to Cite

Mishra, P., Nugent, C., Afendy, A., Bai, C., Bhatia, P., Afendy, M., Fang, Y., Elariny, H., Goodman, Z. and Younossi, Z. M. (2008), Apnoeic–hypopnoeic episodes during obstructive sleep apnoea are associated with histological nonalcoholic steatohepatitis. Liver International, 28: 1080–1086. doi: 10.1111/j.1478-3231.2008.01822.x

Author Information

  1. 1

    Center for Liver Diseases, Inova Fairfax Hospital, Annandale, VA, USA

  2. 2

    Translational Research Institute, Inova Health System, Inova Fairfax Hospital, Annandale, VA, USA

  3. 3

    Armed Forces Institute of Pathology, Washington, DC, USA

*Correspondence Zobair M. Younossi, Center for Liver Disease, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22033, USA Tel: +703 208 6648 Fax: +703 208 6655 e-mail: zobair.younossi@inova.org

Publication History

  1. Issue published online: 6 AUG 2008
  2. Article first published online: 18 JUL 2008
  3. Received 25 November 2007Accepted 20 May 2008

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (159K)

Keywords:

  • apnoea;
  • NASH;
  • sleep

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnoea are associated with metabolic syndrome and atherosclerotic heart disease. This study evaluates the potential association between the NAFLD subtypes and a number of polysomnographical (PSG) parameters.

Methods: This study included patients undergoing bariatric surgery with extensive clinical and histological data for whom complete PSG data before surgery were also available. Excess alcohol intake and other causes of liver disease were excluded. Apnoea, hypopnoea and apnoea–hypopnoea index (AHI) were calculated as described previously.

Results: In this study, a total of 101 patients [77 nonalcoholic steatohepatitis (NASH) and 22 non-NASH controls] with PSG data were included (age 42.9 ± 11.4 years, body mass index 51.6 ± 9.5 kg/m2, fasting serum glucose 117.4 ± 53.4 mg/dl, fasting serum triglycerides 171.3 ± 82.9 mg/dl, 58% hypertension and 33% diabetes mellitus). Subjects with histological NASH had significantly lower lowest desaturation (77 vs. 85%, P=0.006), lower mean nocturnal oxygen saturation (91 vs. 93%, P=0.05), higher AHI (35 vs. 22, P=0.03), higher respiratory disturbance index (46 vs. 21, P=0.02) and higher alanine aminotransferase/aspartate aminotransferase ratio (1.4 vs. 1.3, P=0.05) compared with non-NASH controls. In multivariate analysis, the lowest desaturation (P=0.04) was independently associated with histological NASH. Lowest desaturation and mean nocturnal oxygen saturation were significantly lower in subjects with fibrosis (76 vs. 85%, P=0.004 and 90.4 vs. 93.0%, P=0.02).

Conclusions: Our results suggest that the frequent nocturnal hypoxic episodes in NAFLD patients may be a risk factor for developing NASH. Additional studies are needed to study the effect of optimizing sleep apnoea management on the outcomes of patients with NAFLD.

View Full Article (HTML) Get PDF (159K)