Association of Obstructive Sleep Apnea with Nocturnal Hypoxemia in Metabolic-Associated Fatty Liver Disease Patients

Abstract

Rationale: Obstructive sleep apnea (OSA) is often seen among obese individuals and the obesity has a linear association with MAFLD. The contribution of chronic intermittent nocturnal hypoxia of OSA and association of MAFLD with OSA is an unmet need. The present study aimed to determine the etiology, impact and association of OSA severity and nocturnal hypoxemia among patients ofChronic liver disease (CLD). Methods: In this study, analysis of the medical records and clinical details of the patients of CLD who had undergone polysomnography were analyzed after appropriate inclusion in study as per inclusion and exclusion criteria. After assessing the eligibility criteria, a total of 78 patients were included in the final analysis. Nocturnal hypoxemia was gauged from the baseline oxygen saturation record of study. Presence and severity of OSA were graded as per American Academy of Sleep Medicine (AASM) criteria. The primary objective of the study was to determine the association between OSA severity and nocturnal hypoxemia to the presence of Non-alcoholic Fatty Liver Disease (NAFLD). Secondary objectives were to assess the association of OSA severity and extent of nocturnal hypoxemia to the BMI and to determine the proportions of NAFLD subjects with OSA. Results: A total of 78 patients were screened, of which only 11 (14.1%) were female. Out of these, 56 (71.8%) were classified to MAFLD group while 22 (28.2%) were to the non-MAFLD group. The patients in MAFLD group with mean age of 56.02 years were older as compared to non-MAFLD with mean age of 51.05 years but that was not statistically different. Patients were categorized into MAFLD ( n = 56) and non-MAFLD, representing other etiologies of CLD ( n = 22; ethanol, chronic Hepatitis B virus (HBV), chronic Hepatitis C virus (HCV), cryptogenic, Non-cirrhosis portal fibrosis (NCPF), Primary sclerosing cholangitis (PSC), Autoimmune hepatitis (AIH), sarcoidosis, Wilson's disease). The mean BMI was significantly higher in MAFLD in comparison to non-MAFLD (34.51 ± 8.79 vs. 25.47 ± 5.75; P = 0.000) and also the median AHI of MAFLD group was significantly higher than the non-MAFLD 4.95 {(1.85, 25.47) vs. 0.85 (0.30, 2.72) ( P value < 0.000)} [Table 1]. Among the desaturation indices, the number of desaturations >3% {median of 122.50 (75.00, 241.25) vs. 63.00 (13.75, 158.00), P value 0.009} and average desaturation {mean of (5.04 ± 2.16) vs. (3.78 ± 1.226)%, P value 0.002} were significantly higher in MAFLD versus non-MAFLD group [Table 2]. The AHI and all desaturation parameters, although not statistically significant, were worst in Child B [Table 3]. Conclusion: MAFLD patients have higher prevalence and greater severity of OSA and worse nocturnal desaturation parameters as compared to non-MAFLD patients. OSA is in...

Association Between Metabolic-Associated Fatty Liver Disease and Obstructive Sleep Apnea: A Cross-Sectional Study

“…Recently, a study involving a cohort of patients with chronic liver disease who underwent screening polysomnographies found that patients with MAFLD have a higher prevalence of OSA, a higher likelihood of severe OSA, and more severe nocturnal desaturation compared with non-MAFLD patients. 19 In agreement with findings by Tomar et al, 19 our study found that patients with MAFLD had higher levels of AHI and ODI, as well as worse nocturnal desaturation parameters. We further found that ODI was an independent risk factor for MAFLD.…”

PIVKA-II or AFP has better diagnostic properties for hepatocellular carcinoma diagnosis in high-risk patients

“…Second, we used different cutoff points for a combination of PIVKA-II and AFP as discussed earlier. Third, some associated factors with hepatitis virus or fatty liver such as sleep apnea were not studied (33)(34)(35)(36)(37)(38). No predictor for HCC was studied as well as systematic review (39)(40)(41)(42).…”

Renaming NAFLD to MAFLD: Advantages and Potential Changes in Diagnosis, Pathophysiology, Treatment, and Management

“…Extra-hepatic complications Cardiovascular disease 22 MAFLD better identifies patients with worsening of atherosclerotic cardiovascular disease risk than NAFLD. Obstructive sleep apnea 46 MAFLD patients have higher prevalence and greater severity of obstructive sleep apnea and worse nocturnal desaturation parameters as compared to non-MAFLD patients. Chronic kidney disease 8 MAFLD identifies patients with chronic kidney disease better than NAFLD.…”

“…13 At present, some conclusions have been drawn on the clinical manifestations and extrahepatic complications of MAFLD (Table 1). 8,[21][22][23][44][45][46] Huang et al 47 confirmed that there is no difference in steatosis, hepatitis, and fibrosis between MAFLD and NAFLD. The MAFLD definition better identifies a group with fatty liver and significant fibrosis evaluated by non-invasive tests.…”