Obstructive Sleep Apnea and Non-alcoholic Fatty Liver Disease in Obese Patients Undergoing Bariatric Surgery

Schwenger, Katherine J. P.; Ghorbani, Yasaman; Li, Carrie; Fischer, Sandra E.; Jackson, Timothy; Okrainec, Allan; Allard, Johane P.

doi:10.1007/s11695-020-04514-3

Cited by 15 publications

(12 citation statements)

References 50 publications

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“…Although clinical studies have demonstrated a relationship between OSA and NAFLD, the study on the association between OSA parameters and liver histology in NAFLD, including steatosis, hepatocyte ballooning, and lobular inflammation, is limited. Schwenger et al found the AHI correlated with liver inflammation in a single-center cross-sectional study of 61 patients undergoing bariatric surgery [24], while our study found that AHI is associated with steatosis in correlation analysis.…”

Section: Discussioncontrasting

confidence: 52%

Insulin Resistance, but Not Obstructive Sleep Apnea Is Associated with Hepatic Steatosis in Chinese Patients with Severe Obesity

Zhu¹,

Tang²,

Xiao³

et al. 2023

Obes Facts

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Introduction Severe obesity often present with nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA). Emerging researches suggest OSA plays an important role in NAFLD development and progression while the relationship between OSA and NAFLD is still conflicting . The interaction of OSA and NAFLD should be further evaluated as obesity surges. The purpose of this study was to assess the prevalence of OSA and NAFLD in patients with obesity undergoing bariatric surgery, and evaluate the association between OSA and severity of NAFLD. Methods 141 patients with severe obesity undergoing preoperative polysomnography and intraoperative liver biopsy during bariatric surgery was investigated. Clinical, anthropometric variables, liver enzymes, fasting blood glucose, fasting serum insulin, and homeostasis model assessment (HOMA-IR) were measured. The severity of NAFLD was assessed by degree of steatosis, ballooning, intralobular inflammation and NAFLD activity score (NAS). The diagnosis and severity assessment of OSA was based on an apnea/hypopnea index (AHI). Results OSA was diagnosed in 127 (90.07%), NAFLD in 124 (87.94%), and non-alcoholic steatohepatitis (NASH) in 72 (51.06%) patients. There was a statistically difference in body mass index (BMI), waist circumstance, neck circumstance, high-density lipoprotein-cholesterol (HDL), fasting insulin, and HOMA-IR among the three groups divided by the severity of AHI. In addition, the distribution of hepatic steatosis grades among the three groups was statistically different (P=0.025). AHI was significantly associated with HOMA-IR and hepatic steatosis when assessing the association between OSA parameters and liver histology in NAFLD(P< 0.05). Patients with steatosis of grade 1-3 had significantly elevated aspartate aminotransferase(AST), alanine aminotransferase(ALT), gamma glutamyl transferase (GGT),triglycerides (TG), fasting insulin, fasting glucose, HOMA-IR, and AHI compared with the patients with steatosis of grade 0. In a multivariable logistic analysis, the positive association between AHI and hepatic steatosis attenuated after adjusting for HOMA-IR. Conclusion Prevalence of OSA and NAFLD was high in patients with obesity eligible for bariatric procedures. HOMA-IR, but not AHI, was an independent risk factor for hepatic steatosis in this population.

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Section: Discussioncontrasting

confidence: 52%

Insulin Resistance, but Not Obstructive Sleep Apnea Is Associated with Hepatic Steatosis in Chinese Patients with Severe Obesity

Zhu¹,

Tang²,

Xiao³

et al. 2023

Obes Facts

View full text Add to dashboard Cite

show abstract

“…An increasing number of clinical studies point out to a potential link between obstructive sleep apnea (OSA), a respiratory disorder featured by nocturnal intermittent hypoxia (IH) and sleep fragmentation, and NAFLD ( 15 – 18 ). To highlight, both OSA and NAFLD are especially prevalent among obese individuals and, more interestingly, the severity of nocturnal IH positively correlates with histological features of NASH in OSA patients ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

Intrahepatic Expression of Fatty Acid Translocase CD36 Is Increased in Obstructive Sleep Apnea

et al. 2020

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Nocturnal intermittent hypoxia (IH) featuring obstructive sleep apnea (OSA) dysregulates hepatic lipid metabolism and might contribute to the development of non-alcoholic fatty liver disease (NAFLD) observed in OSA patients. However, further research is required to better understanding the molecular mechanisms underlying IH-induced hepatic lipid accumulation. Therefore, the aim of the present study was to determine the effects of OSA on hepatic CD36 expression and the impact of IH by using a mouse model of OSA. Histological analysis, lipid content and CD36 expression were assessed in livers from subjects who underwent liver biopsy and polygraphic study during sleep, and in livers from mice submitted to chronic IH mimicking OSA. Among those who presented OSA features, NAFLD were significantly more frequent than in control subjects with normal respiratory function (77.8 vs. 36.4%, respectively), and showed more severe liver disease. Interestingly, CD36 expression was significantly overexpressed within the liver of OSA patients with respect to controls, and a significant positive correlation was observed between hepatic levels of CD36 and the values of two well-known respiratory parameters that characterized OSA: apnea/hypopnea index (AHI) and oxygen desaturation index (ODI). Moreover, hepatic lipid accumulation as well as induction of hepatic lipogenic genes, and CD36 mRNA and protein expression were significantly higher in livers from mice exposed to IH conditions for 8 weeks than in their corresponding littermates. This study provides novel evidence that IH featuring OSA could contribute to NAFLD setup partly by upregulating hepatic CD36 expression.

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“…After evaluating 603 full-text articles, this systematic review included in total 28 studies. (18 cross-sectional studies [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], and 10 cohort trials [38][39][40][41][42][43][44][45][46][47]) (Fig. 1).…”

Section: Literature Searchmentioning

confidence: 99%

Effects of obstructive sleep apnea on non-alcoholic fatty liver disease in patients with obesity: a systematic review

Hany,

Abouelnasr,

Abdelkhalek

et al. 2023

Int J Obes

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Introduction Obesity has been linked to non-alcoholic fatty liver disease (NAFLD), a widespread chronic liver ailment, as well as obstructive sleep apnea (OSA). The development of NAFLD is influenced by repeated intermittent hypoxia, a feature of OSA. Methods This systematic review (SR) investigated CENTRAL, PubMed, and EMBASE databases. The endpoint of this SR was to assess which OSA-related indicators could predict the presence of NAFLD and the effect of bariatric metabolic surgery (BMS) on improving OSA and NAFLD over time. Results Compared to previous SRs published in 2013, 14 new publications were added to our SR, alongside studies conducted prior to 2013. The SR ultimately included 28 studies (18 cross-sectional and 10 cohort trials). In the majority of studies, significant correlations were observed between OSA, OSA-related outcomes, and NAFLD. However, the apnea-hypopnea index (AHI) alone proved to be an inadequate predictor of NAFLD. Instead, respiratory and metabolic changes were found to alleviate oxidative stress induced by hypoxemia. Six studies involved patients who underwent BMS, with one evaluating patients before and after BMS, revealing associations between increased OSA and NAFLD improvement following BMS. Six months after surgery, 100% of patients in the mild-to-moderate OSA group were free from fatty liver, and an 89% reduction was observed in the severe OSA group. Conclusion For the first time, BMS has been tested in treating both OSA and NAFLD pre and postoperative with positive results. Further research, ideally with histological and functional data, is needed to confirm these findings. The SR identified 14 distinct liver outcome tests; however, high heterogeneity and incomplete data precluded a meta-analysis. It is imperative to pay greater attention to the influence of OSA-related factors and uniformity in liver outcomes testing concerning NAFLD. To accomplish this, study designs should be enhanced by incorporating more comprehensive pre- and postoperative evaluations, extending follow-up periods, and employing a more consistent methodology for liver diagnosis in patients with obesity.

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Obstructive Sleep Apnea and Non-alcoholic Fatty Liver Disease in Obese Patients Undergoing Bariatric Surgery

Cited by 15 publications

References 50 publications

Insulin Resistance, but Not Obstructive Sleep Apnea Is Associated with Hepatic Steatosis in Chinese Patients with Severe Obesity

Insulin Resistance, but Not Obstructive Sleep Apnea Is Associated with Hepatic Steatosis in Chinese Patients with Severe Obesity

Intrahepatic Expression of Fatty Acid Translocase CD36 Is Increased in Obstructive Sleep Apnea

Effects of obstructive sleep apnea on non-alcoholic fatty liver disease in patients with obesity: a systematic review

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