Clinical study
Effects of obstructive sleep apnea syndrome on serum aminotransferase levels in obese patients

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Abstract

Purpose

Obesity has been associated with obstructive sleep apnea and hepatic steatosis. We investigated the effects of obstructive sleep apnea and treatment with nasal continuous positive airway pressure (CPAP) on serum aminotransferase levels in obese patients.

Methods

We studied 40 obese men with obstructive sleep apnea syndrome. None had hepatitis B antigen or C antibody, autoimmune disease, or an excessive intake of alcohol. Serum levels of aspartate aminotransferase, alanine aminotransferase, triglyceride, glucose, insulin, and leptin were determined in the afternoon and in the morning immediately after sleep, before and after nasal CPAP treatment.

Results

Aminotransferase levels were abnormal in 35% (n = 14) of patients. Before treatment, mean (± SD) aspartate aminotransferase levels were higher in the morning than in the previous afternoon (presleep, 34 ± 20 IU/L; postsleep, 39 ± 28 IU/L; P = 0.006). The overnight mean increases in aminotransferase levels were less marked after the first night of nasal CPAP treatment (aspartate aminotransferase: from 6 ± 11 IU/L to 2 ± 6 IU/L, P = 0.0003; alanine aminotransferase: from 5 ± 9 IU/L to 2 ± 6 IU/L, P = 0.006). Leptin levels (n = 23) decreased significantly after treatment (P = 0.0002), whereas insulin resistance (calculated by the homeostasis model assessment method) and triglyceride levels were unchanged. Improvements in aspartate and alanine aminotransferase levels were maintained after 1 and 6 months of nasal CPAP treatment.

Conclusion

Nasal CPAP therapy may have beneficial effects on serum aminotransferase abnormalities in obese patients who have obstructive sleep apnea.

Section snippets

Subjects

We studied 44 consecutive patients (41 men, 3 women; mean [± SD] age, 47 ± 12 years) with obstructive sleep apnea syndrome who were determined by polysomnography and clinical symptoms to be candidates for nasal CPAP treatment (2). Polysomnography was performed in the hospital before CPAP treatment and on the first night of CPAP therapy 1 week later. All patients were obese by Japanese criteria (body mass index >25 kg/m2). We could not obtain blood from 2 patients, and samples from 2 other

Results

Patients were middle-aged men with minimal use of alcohol (Table 1). All but 1 patient ingested less than 30 g/d of alcohol; that patient ingested 50 g/d. There was no past history of alcohol ingestion greater than 30 g/d. The ratio of the levels of alanine to aspartate aminotransferase was >1 in 35 (88%) of the 40 patients, whereas the ratio of visceral to subcutaneous was >0.4 (the criterion for visceral obesity) in 37 (97%) of the 38 patients in whom it was measured. Eleven patients had

Discussion

We found that about one third of obese patients with moderate or severe obstructive sleep apnea had abnormal aminotransferase levels, and that aminotransferase levels correlated significantly with insulin resistance. Results from a single night of nasal CPAP treatment, as well as from other reports 3, 4, 5, 23, suggest that recurrent apnea and hypopnea with hypoxemia may aggravate hepatic dysfunction in these patients, as manifest by release of aspartate aminotransferase, a well-established

Acknowledgements

We are grateful to Tomoko Toki for manuscript preparation.

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    This work was supported in part by grants from the Tahei Ueda Memorial Fund; the Japan Vascular Disease Research Foundation; the Japanese Ministry of Education, Culture, Sports, Science, and Technology; and the Japanese Ministry of Health, Labour and Welfare.

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