Association between continuous positive airway pressure and serum aminotransferases in patients with obstructive sleep apnea

Chen, Li-Da; Zhang, Liang-Ji; Lin, Xue‐Jun; Qi, Jia-Chao; Li, Hao; Wu, Zhi; Xu, Qiao-Zhen; Huang, Ya‐Ping; Lin, Li

doi:10.1007/s00405-017-4840-0

Cited by 14 publications

(9 citation statements)

References 24 publications

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“…In humans, many associative studies have examined the effect of OSA on hepatic steatosis, with results seemingly supportive of the role of OSA in modulating this early NAFLD phenotype. In fact, several markers of OSA severity have been linked to liver fat content, including AHI (80)(81)(82), time with oxyhemoglobin saturation less than 90% (83), oxyhemoglobin desaturation index (84), and mean (81) and nadir (85) nocturnal oxyhemoglobin saturation. Although some earlier studies were not adjusted for common covariates such as obesity (80), careful multivariate analysis has been performed in larger recent studies.…”

Section: Osa Hypoxia and Hepatic Steatosismentioning

confidence: 99%

Obstructive Sleep Apnea, Hypoxia, and Nonalcoholic Fatty Liver Disease

Mesarwi

Loomba

Malhotra

2019

Am J Respir Crit Care Med

170

121

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Recent studies have demonstrated that obstructive sleep apnea (OSA) is associated with the development and evolution of nonalcoholic fatty liver disease (NAFLD), independent of obesity or other shared risk factors. Like OSA, NAFLD is a prevalent disorder associated with major adverse health outcomes: Patients with NAFLD may develop cirrhosis, liver failure, and hepatocellular carcinoma. One major finding that has emerged from these studies is that the OSA-NAFLD association is related to the degree of nocturnal hypoxemia in OSA. Animal models have therefore largely focused on intermittent hypoxia, a key manifestation of OSA, to shed light on the mechanisms by which OSA may give rise to the complex metabolic disturbances that are seen in NAFLD. Intermittent hypoxia leads to tissue hypoxia and can result in oxidative stress, mitochondrial dysfunction, inflammation, and overactivation of the sympathetic nervous system, among many other maladaptive effects. In such models, intermittent hypoxia has been shown to cause insulin resistance, dysfunction of key steps in hepatic lipid metabolism, atherosclerosis, and hepatic steatosis and fibrosis, each of which is pertinent to the development and/or progression of NAFLD. However, many intriguing questions remain unanswered: Principally, how aggressively should the clinician screen for NAFLD in patients with OSA, and vice versa? In this review, we attempt to apply the best evidence from animal and human studies to highlight the relationship between these two disorders and to advocate for further trials aimed at defining these relationships more precisely.

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Section: Osa Hypoxia and Hepatic Steatosismentioning

confidence: 99%

Obstructive Sleep Apnea, Hypoxia, and Nonalcoholic Fatty Liver Disease

Mesarwi

Loomba

Malhotra

2019

Am J Respir Crit Care Med

170

121

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“…However, the available studies have yielded mixed results and are listed in Table 2 and Table 3. 80,[87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102] In these studies, the impact of CPAP therapy on NAFLD was assessed by means of improvements in liver enzymes, hepatic adiposity, or fibrosis. Importantly, the observational studies that demonstrated the benefits of CPAP (see Table 2) were of longer duration than the randomized controlled trials that did not show CPAP to be beneficial (see Table 3).…”

Section: Obstructive Sleep Apnea and Liver Fibrosismentioning

confidence: 99%

Obstructive Sleep Apnea and the Liver

Parikh

Gupta

McCullough

2019

Clinics in Liver Disease

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“…Similarly, patients with NAFLD have a higher apnoea-hypopnoea index and lower mean nocturnal oxygen saturation than controls (108,109), and these are independent risk factors for progression to hepatic fibrosis (110,111). In addition, increasing severity of OSA appears to be in a dose-relationship with the prevalence of NAFLD (112) and severity of liver dysfunction, both in terms of transaminases (113,114) and liver morphology (115)(116)(117).…”

Section: Lox-1 Overexpressionmentioning

confidence: 99%

Sleep disorder in patients with chronic liver disease: a narrative review

Shah¹,

Malhotra²,

Kaltsakas³

2020

J Thorac Dis

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Sleep disturbance is a common feature of chronic liver disease (CLD) with impact on healthrelated quality of life; 60-80% of patients with CLD report subjective poor sleep; frequent presentations of sleep disturbance include insomnia, reduced sleep efficiency, increased sleep latency, reduced time in rapid eye movement (REM) sleep, restless leg syndrome and excessive daytime sleepiness (EDS). Key contributors to sleep disturbance include hepatic encephalopathy (HE) and circadian rhythm imbalance due to altered melatonin metabolism. Specific conditions causing CLD, such as non-alcoholic fatty liver disease (NAFLD), chronic viral hepatitis and primary biliary cholangitis (PBC) result in different types of sleep disturbance, and the treatment of these conditions can often also lead to sleep disturbance. There are currently limited management options for sleep disturbance in CLD. Obstructive sleep apnoea (OSA) is a common condition that causes chronic intermittent hypoxia due to airway collapse during sleep. This chronic intermittent hypoxia appears to contribute to the development of NAFLD. The presence of reactive oxygen species and the overexpression of hypoxia inducible factor 1-alpha secondary to hypoxia may be responsible for the second 'hit' of the 'two-hit' hypothesis of NAFLD. Treatment of the intermittent hypoxia with continuous positive airway pressure therapy has limited efficacy against liver dysfunction. There remain many outstanding areas of investigation in the management of sleep disturbance in CLD, and of liver dysfunction in OSA.

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Association between continuous positive airway pressure and serum aminotransferases in patients with obstructive sleep apnea

Abstract: OSA severity was independently associated with liver steatosis and elevation of serum aminotransferases. 3 months of CPAP therapy were associated with a statistically significant improvement on liver injury in OSA patients.

Cited by 14 publications

References 24 publications

Obstructive Sleep Apnea, Hypoxia, and Nonalcoholic Fatty Liver Disease

Obstructive Sleep Apnea, Hypoxia, and Nonalcoholic Fatty Liver Disease

Obstructive Sleep Apnea and the Liver

Sleep disorder in patients with chronic liver disease: a narrative review

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