Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Non-Alcoholic Steatohepatitis: A Systematic Review and Meta-Analysis

Labarca, Gonzalo; Cruz, Rodrigo; Jorquera, Jorge

doi:10.5664/jcsm.6900

Cited by 27 publications

(17 citation statements)

References 41 publications

(47 reference statements)

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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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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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“…However, the duration of CPAP treatment was less than two months in these trials, so the authors concluded that the lack of favorable results was probably due to the short treatment course. Finally, another recent meta-analysis confirmed these findings, showing no difference in improvement of liver steatosis and markers of liver injury after CPAP treatment [118].…”

Section: Resultsmentioning

confidence: 75%

“…Improvement in hepatic disease also improves renal function [90]. Obstructive Sleep ApneaOSA is significantly associated with more “severe” forms of NAFLD and the treatment of OSA with CPAP therapy seems to improve the liver injury [103,104,110,111,112,113,114,115,116,117,118,119]. EndocrinopathiesPolycystic ovarian syndromeHypothyroidismObesity and IR are common risk factors for both PCOS and NAFLD [207,208,209,210].…”

Section: Table A1mentioning

confidence: 99%

NAFLD and Extra-Hepatic Comorbidities: Current Evidence on a Multi-Organ Metabolic Syndrome

Rosato

Masarone

Dallio

et al. 2019

IJERPH

104

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Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and its incidence is definitely increasing. NAFLD is a metabolic disease with extensive multi-organ involvement, whose extra-hepatic manifestations include type 2 diabetes mellitus, cardiovascular disease, obstructive sleep apnea, chronic kidney disease, osteoporosis, and polycystic ovarian syndrome. Recently, further evidence has given attention to pathological correlations not strictly related to metabolic disease, also incorporating in this broad spectrum of systemic involvement hypothyroidism, psoriasis, male sexual dysfunction, periodontitis, and urolithiasis. The most common cause of mortality in NAFLD is represented by cardiovascular disease, followed by liver-related complications. Therefore, clinicians should learn to screen and initiate treatment for these extra-hepatic manifestations, in order to provide appropriate multidisciplinary assessments and rigorous surveillance. This review evaluates the current evidence regarding extra-hepatic associations of NAFLD, focusing on the pathogenic hypothesis and the clinical implications.

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“…Continuous positive airway pressure (CPAP) is considered the gold standard treatment with OSA patient, and this treatment is marginally effective in reducing elevated arterial pressure (~2 mmHg), and sympathetic nerve activity and partially restoring chemoreflex and baroreflex sensitivity [ 14 , 15 ]. However, the use of CPAP was not associated with reduced risks of cardiovascular outcomes, diabetes mellitus, or death for patients with OSA in recent randomized controlled trials [ 16 , 17 , 18 ]. Therefore, it is essential to develop novel pharmacological agents to counteract the pathophysiological mechanisms responsible for OSA-related adverse consequences, namely oxidative stress, sympathetic activation, and low-grade inflammation [ 16 ].…”

Section: Sleep Apnea and Metabolic Dysfunctionmentioning

confidence: 99%

The Mystery of Red Blood Cells Extracellular Vesicles in Sleep Apnea with Metabolic Dysfunction

Sanz-Rubio

2021

IJMS

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Sleep is very important for overall health and quality of life, while sleep disorder has been associated with several human diseases, namely cardiovascular, metabolic, cognitive, and cancer-related alterations. Obstructive sleep apnea (OSA) is the most common respiratory sleep-disordered breathing, which is caused by the recurrent collapse of the upper airway during sleep. OSA has emerged as a major public health problem and increasing evidence suggests that untreated OSA can lead to the development of various diseases including neurodegenerative diseases. In addition, OSA may lead to decreased blood oxygenation and fragmentation of the sleep cycle. The formation of free radicals or reactive oxygen species (ROS) can emerge and react with nitric oxide (NO) to produce peroxynitrite, thereby diminishing the bioavailability of NO. Hypoxia, the hallmark of OSA, refers to a decline of tissue oxygen saturation and affects several types of cells, playing cell-to-cell communication a vital role in the outcome of this interplay. Red blood cells (RBCs) are considered transporters of oxygen and nutrients to the tissues, and these RBCs are important interorgan communication systems with additional functions, including participation in the control of systemic NO metabolism, redox regulation, blood rheology, and viscosity. RBCs have been shown to induce endothelial dysfunction and increase cardiac injury. The mechanistic links between changes of RBC functional properties and cardiovascular are largely unknown. Extracellular vesicles (EVs) are secreted by most cell types and released in biological fluids both under physiological and pathological conditions. EVs are involved in intercellular communication by transferring complex cargoes including proteins, lipids, and nucleic acids from donor cells to recipient cells. Advancing our knowledge about mechanisms of RBC-EVs formation and their pathophysiological relevance may help to shed light on circulating EVs and to translate their application to clinical practice. We will focus on the potential use of RBC-EVs as valuable diagnostic and prognostic biomarkers and state-specific cargoes, and possibilities as therapeutic vehicles for drug and gene delivery. The use of RBC-EVs as a precision medicine for the diagnosis and treatment of the patient with sleep disorder will improve the prognosis and the quality of life in patients with cardiovascular disease (CVD).

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Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea and Non-Alcoholic Steatohepatitis: A Systematic Review and Meta-Analysis

Abstract: PROSPERO; ID: CRD42015027981; URL: https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42015027981.

Cited by 27 publications

References 41 publications

Obstructive Sleep Apnea and the Liver

Obstructive Sleep Apnea and the Liver

NAFLD and Extra-Hepatic Comorbidities: Current Evidence on a Multi-Organ Metabolic Syndrome

The Mystery of Red Blood Cells Extracellular Vesicles in Sleep Apnea with Metabolic Dysfunction

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