Skip to main content

Advertisement

SpringerLink
Log in

Nonalcoholic Fatty Liver Disease Associated with Obstructive Sleep Apnea: Just a Coincidence?

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Obesity is associated with obstructive sleep apnea (OSA) and nonalcoholic fatty liver disease (NAFLD). It has been shown that OSA could be an independent risk factor for NAFLD. OSA could cause not only insulin resistance but worse NAFLD through nocturnal hypoxemia. This study aimed to evaluate the frequency of OSA and NAFLD in obese patients and the relationship between OSA, insulin resistance, and severity of steatohepatitis (nonalcoholic steatohepatitis (NASH)).

Methods

Forty obese patients submitted to bariatric surgery were evaluated. Sleep studies, fasting blood glucose, serum insulin, homeostasis model assessment (HOMA-IR), and liver enzymes were measured. Liver biopsies were evaluated for features of NAFLD including degrees of steatosis, inflammation, cellular ballooning, and fibrosis. NASH was diagnosed in those with steatosis + ballooning or steatosis + fibrosis. The diagnosis of OSA was based on an apnea/hypopnea index (AHI) ≥ 5 events/hours.

Results

OSA was present in 32 (80.0%), NAFLD in 33 (82.5%), and NASH in 32 (80.0%) patients. Patients with AHI ≥ 15 ev/h had higher serum insulin levels (30.0 ± 12.8 vs. 22.6 ± 17.3 μU/ml; p = 0.015) and HOMA-IR (7.5 ± 4.0 vs. 5.4 ± 4.1; p = 0.016) when compared with those with AHI < 15 ev/h, but no association was found between AHI and NASH (81.0% vs. 78.9%; p = 1.000) or oxihemoglobin desaturation <84% and NASH (81.2% vs. 70.8%; p = 0.709) when these groups were compared.

Conclusions

Obese patients had elevated OSA and NAFLD frequencies. OSA was associated with insulin resistance but not with the severity of NASH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22:667–89.

    Google Scholar 

  2. Makino S, Handa H, Suzukawa K, et al. Obstructive sleep apnoea syndrome, plasma adiponectin levels and insulin resistance. Clin Endocrinol. 2006;64:12–9.

    Article  CAS  Google Scholar 

  3. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab. 2000;85:1151–8.

    Article  CAS  PubMed  Google Scholar 

  4. Ip MSM, Lam B, MMT NG, et al. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165:670–6.

    PubMed  Google Scholar 

  5. Punjabi NM, Sorkin JD, Katzel LI, et al. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med. 2002;165:677–82.

    PubMed  Google Scholar 

  6. Vgontzas AN. Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity and insulin resistance? Arch Physiol Biochem. 2008;114(4):211–23.

    Article  CAS  PubMed  Google Scholar 

  7. Day CP, James OF. Steatohepatitis: a tale of two “hits”? Gastroenterology. 1998;114(4):842–5.

    Article  CAS  PubMed  Google Scholar 

  8. Savransky V, Nanayakkara A, Vivero A, et al. Chronic intermittent hypoxia predisposes to liver injury. Hepatology. 2007;45:1007–13.

    Article  CAS  PubMed  Google Scholar 

  9. Rechtschaffen A, Kales A. A manual of standardized terminology, techniques, and scoring system for sleep stages in human subjects. Brain Information Service, UCLA: Los Angeles; 1968.

  10. Steiropoulos P, Papanas N, Nena E, et al. A Markers of glycemic control and insulin resistance in non-diabetic patients with obstructive sleep apnea hypopnea syndrome: does adherence to CPAP treatment improve glycemic control? Sleep Med. 2009;10(8):887–91.

    Article  PubMed  Google Scholar 

  11. Cuhadaroglu C, Utkusavaş A, Oztürk L, et al. Effects of nasal CPAP treatment on insulin resistance, lipid profile, and plasma leptin in sleep apnea. Lung. 2009;187(2):75–81.

    Article  CAS  PubMed  Google Scholar 

  12. Daltro C, Araújo L, Cotrim HP. Obstructive sleep apnoea and nonalcoholic fatty liver disease: risk factor or just coincidence? Liver Int. 2008;28(8):1047–9.

    Article  PubMed  Google Scholar 

  13. Chin K, Nakamura T, Takahashi K, et al. Effects of sleep apnea syndrome on serum aminotransferase levels in obese patients. Am J Med. 2003;114:370–6.

    Article  CAS  PubMed  Google Scholar 

  14. Tatsumi K, Saibara T. Effects of obstructive sleep apnea syndrome on hepatic steatosis and nonalcoholic steatohepatitis. Hepatol Res. 2005;33:100–4.

    Article  PubMed  Google Scholar 

  15. Tanné F, Gagnadoux F, Chazouillères O, et al. Chronic liver injury during obstructive sleep apnea. Hepatology. 2005;41:1290–6.

    Article  PubMed  Google Scholar 

  16. Singh H, Pollock R, Uhanova J, et al. Symptoms of obstructive sleep apnea in patients with nonalcoholic fatty liver disease. Dig Dis Sci. 2005;50:2338–43.

    Article  PubMed  Google Scholar 

  17. Kohler M, Pepperell JC, Davies RJ, et al. Continuous positive airway pressure and liver enzymes in obstructive sleep apnoea: data from a randomized controlled trial. Respiration. 2009;78(2):141–6.

    Article  CAS  PubMed  Google Scholar 

  18. Jouët P, Sabaté JM, Maillard D, et al. Relationship between obstructive sleep apnea and liver abnormalities in morbidly obese patients: a prospective study. Obes Surg. 2007;17:478–85.

    Article  PubMed  Google Scholar 

  19. Kallwitz ER, Herdegen J, Madura J, et al. Liver enzymes and histology in obese patients with obstructive sleep apnea. J Clin Gastroenterol. 2007;41:918–21.

    Article  CAS  PubMed  Google Scholar 

  20. Mishra P, Nugent C, Afendy A, et al. Apneic-hypopneic episodes during obstructive sleep apnea are associated with histologic nonalcoholic steatohepatitis. Liver Int. 2008;28(8):1080–6.

    Article  CAS  PubMed  Google Scholar 

  21. Polotsky VY, Patil SP, Savransky V, et al. Obstructive sleep apnea, insulin resistance and steatohepatitis in severe obesity. Am J Respir Crit Care Med. 2009;179(3):228–34.

    Article  PubMed  Google Scholar 

  22. Daltro C, Gregorio PB, Alves E, et al. Prevalence and severity of sleep apnea in a group of morbidly obese patients. Obes Surg. 2007;17(6):809–14.

    Article  PubMed  Google Scholar 

  23. Brunt E, Kleiner DE, Wilson LA, et al. Portal chronic inflammation in Nonalcoholic Fatty Liver Disease (NAFLD): a histologic marker of advanced NAFLD–clinicopathologic correlations from the Nonalcoholic Steatohepatitis Clinical Research Network. Hepatology. 2009;49:809–20.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that they have no conflict of interest.

Financial Disclosures

The medical student Leonardo Boente received research support from Fundação de Amparo à Pesquisa do Estado da Bahia (FAPESB—BOL0554/2008). The rest of the authors did not receive any funds for this research.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Bahiana School of Medicine and Public Health, Rua Clarival do Prado Valladares, 264/803, Salvador, Bahia, 41.820-700, Brazil

    Carla Daltro, Leonardo Boente, Rafael Leal & Thaís Portugal

  2. Department of Internal Medicine Hepatology, Bahia Federal University of Medicine, Salvador, Bahia, Brazil

    Helma P. Cotrim

  3. Obesity Treatment and Surgery Center, Salvador, Bahia, Brazil

    Erivaldo Alves

  4. Department of Pathology, Bahia Federal University of Medicine, Salvador, Bahia, Brazil

    Luiz Antônio de Freitas

  5. Department of Internal Medicine, Bahia Federal University of Medicine, Salvador, Bahia, Brazil

    Leila Araújo

Authors
  1. Carla Daltro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helma P. Cotrim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erivaldo Alves
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luiz Antônio de Freitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leila Araújo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leonardo Boente
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rafael Leal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thaís Portugal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carla Daltro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Daltro, C., Cotrim, H.P., Alves, E. et al. Nonalcoholic Fatty Liver Disease Associated with Obstructive Sleep Apnea: Just a Coincidence?. OBES SURG 20, 1536–1543 (2010). https://doi.org/10.1007/s11695-010-0212-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-010-0212-1

Keywords

Search

Navigation