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1. Obstructive Sleep Apnea Is Associated with Liver Damage and Atherosclerosis in Patients with Non-Alcoholic Fatty Liver Disease

Author

Salvatore Petta, Vito Di Marco, Antonio Craxì, Oreste Marrone, Maria R. Bonsignore, Anna Licata, Adriana Salvaggio, Anna Lo Bue, Antonino Tuttolomondo, Calogero Cammà, Gaspare Parrinello, Maria Buttacavoli, Antonio Pinto, Daniele Torres, Petta, S., Marrone, O., Torres, D., Buttacavoli, M., Cammà, C., Di Marco, V., Licata, A., Lo Bue, A., Parrinello, G., Pinto, A., Salvaggio, A., Tuttolomondo, A., Craxì, A., and Bonsignore, M.

Subjects
Adult, Carotid Artery Diseases, Liver Cirrhosis, Male, medicine.medical_specialty, Biopsy, lcsh:Medicine, Polysomnography, Severity of Illness Index, Gastroenterology, Liver Function Tests, Non-alcoholic Fatty Liver Disease, Risk Factors, Surveys and Questionnaires, Internal medicine, Severity of illness, Prevalence, medicine, Humans, Hypoxia, lcsh:Science, Aged, NAFLD, OSAS, ATHEROSCLEROSIS, Sleep Apnea, Obstructive, Multidisciplinary, medicine.diagnostic_test, business.industry, lcsh:R, Fatty liver, Apnea, Sleep apnea, Middle Aged, Atherosclerosis, medicine.disease, Plaque, Atherosclerotic, respiratory tract diseases, 3. Good health, Obstructive sleep apnea, Endocrinology, Female, lcsh:Q, medicine.symptom, business, Liver function tests, Hypopnea, Research Article
Abstract

Background/Aims We assessed whether obstructive sleep apnea (OSA) and nocturnal hypoxemia are associated with severity of liver fibrosis and carotid atherosclerosis in patients with biopsy-proven NAFLD and low prevalence of morbid obesity. Secondary aim was to explore the association of OSA and hypoxemia with NASH and severity of liver pathological changes. Methods Consecutive patients (n = 126) with chronically elevated ALT and NAFLD underwent STOP-BANG questionnaire to estimate OSA risk and ultrasonographic carotid assessment. In patients accepting to perform cardiorespiratory polygraphy (PG, n = 50), OSA was defined as an apnea/hypopnea index ≥5. A carotid atherosclerotic plaque was defined as a focal thickening >1.3 mm. Results Prevalence of high OSA risk was similar in patients refusing or accepting PG (76% vs 68%, p = 0.17). Among those accepting PG, overall OSA prevalence was significantly higher in patients with F2-F4 fibrosis compared to those without (72% vs 44%; p = 0.04). Significant fibrosis was independently associated with mean nocturnal oxygen saturation (SaO2)1 (OR 6.30, 95%C.I. 1.02–12.3; p = 0.01). Conclusions In NAFLD patients with chronically elevated ALT at low prevalence of morbid obesity, OSA was highly prevalent and indexes of SaO2 resulted independently associated with severity of liver fibrosis and carotid atherosclerosis. These data suggest to consider sleep disordered breathing as a potential additional therapeutic target in severe NAFLD patients.

Published
2015
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2. Obstructive Sleep Apnea Is Associated with Liver Damage and Atherosclerosis in Patients with Non-Alcoholic Fatty Liver Disease.

Author

Petta S, Marrone O, Torres D, Buttacavoli M, Cammà C, Di Marco V, Licata A, Lo Bue A, Parrinello G, Pinto A, Salvaggio A, Tuttolomondo A, Craxì A, and Bonsignore MR

Subjects
Adult, Aged, Atherosclerosis diagnosis, Biopsy, Carotid Artery Diseases diagnosis, Carotid Artery Diseases epidemiology, Carotid Artery Diseases etiology, Female, Humans, Hypoxia complications, Liver Cirrhosis diagnosis, Liver Function Tests, Male, Middle Aged, Non-alcoholic Fatty Liver Disease epidemiology, Plaque, Atherosclerotic metabolism, Plaque, Atherosclerotic pathology, Prevalence, Risk Factors, Severity of Illness Index, Sleep Apnea, Obstructive diagnosis, Sleep Apnea, Obstructive epidemiology, Surveys and Questionnaires, Atherosclerosis epidemiology, Atherosclerosis etiology, Liver Cirrhosis epidemiology, Liver Cirrhosis etiology, Non-alcoholic Fatty Liver Disease complications, Sleep Apnea, Obstructive complications
Abstract

Background/aims: We assessed whether obstructive sleep apnea (OSA) and nocturnal hypoxemia are associated with severity of liver fibrosis and carotid atherosclerosis in patients with biopsy-proven NAFLD and low prevalence of morbid obesity. Secondary aim was to explore the association of OSA and hypoxemia with NASH and severity of liver pathological changes., Methods: Consecutive patients (n = 126) with chronically elevated ALT and NAFLD underwent STOP-BANG questionnaire to estimate OSA risk and ultrasonographic carotid assessment. In patients accepting to perform cardiorespiratory polygraphy (PG, n = 50), OSA was defined as an apnea/hypopnea index ≥5. A carotid atherosclerotic plaque was defined as a focal thickening >1.3 mm., Results: Prevalence of high OSA risk was similar in patients refusing or accepting PG (76% vs 68%, p = 0.17). Among those accepting PG, overall OSA prevalence was significantly higher in patients with F2-F4 fibrosis compared to those without (72% vs 44%; p = 0.04). Significant fibrosis was independently associated with mean nocturnal oxygen saturation (SaO2)<95% (OR 3.21, 95%C.I. 1.02-7.34; p = 0.04). Prevalence of OSA tended to be higher in patients with, than in those without, carotid plaques (64% vs 40%; p = 0.08). Carotid plaques were independently associated with %time at SaO2<90% >1 (OR 6.30, 95%C.I. 1.02-12.3; p = 0.01)., Conclusions: In NAFLD patients with chronically elevated ALT at low prevalence of morbid obesity, OSA was highly prevalent and indexes of SaO2 resulted independently associated with severity of liver fibrosis and carotid atherosclerosis. These data suggest to consider sleep disordered breathing as a potential additional therapeutic target in severe NAFLD patients.

Published
2015
Full Text
View/download PDF

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