The association of nonalcoholic steatohepatitis and obstructive sleep apnea

Abstract

Background and Aims The association between obstructive sleep apnea (OSA) and abnormal liver enzymes has been reported in multiple studies. The existing literature regarding the relationship between OSA and nonalcoholic steatohepatitis (NASH) is conflicting. Thus we aimed to determine the relationship between OSA and NASH from a large database. Methods A cross-sectional study was performed using the 2012 Nationwide Inpatient Sample. We identified adult patients (18–90 year) who had a diagnosis of OSA using the International Classification of Diseases ICD-9 codes. The control group was comprised of adult individuals with no discharge records of OSA. NASH diagnosis was also identified using the ICD-9 codes. The association between OSA and NASH was calculated using univariable and multivariable logistic regression. Results 30,712,524 hospitalizations were included. The OSA group included 1,490,150 patients versus 29,222,374 in the control non-OSA group. The OSA group average age was 61.8±0.07 years (44.2% females) compared to 57.0±0.11 years (60.1% females) in the non-OSA group. NASH prevalence was significantly higher in the OSA group compared to the non-OSA group [2% (95% CI: 1.9, 2.1) versus 0.65% (0.63, 0.66), p<0.001]. After adjusting for obesity, diabetes, hypertension, dyslipidemia, the metabolic syndrome and Charlson comorbidity index, OSA patients were 3 times more likely to have NASH [adjusted OR:3.1 (95% CI: 3.0 – 3.3), p<0.001]. Conclusions Patients with OSA are three times more likely to have NASH compared to patients without OSA after controlling for other confounders. These data indicate that OSA should be considered as an independent risk factor for developing NASH.

Real-World Burden of Nonalcoholic Steatohepatitis

“…In other published studies it is reported that up to 70% of patients with NASH had comorbidities, 17,18 but in our study, comorbidities were reported in 41% of patients, with type 2 diabetes mellitus and hypertension being the most common. One discrepancy noted in our data was that only 239 patients had a clinical diagnosis of obesity, whereas a body mass index !30 (obese/ morbidly obese) was recorded in 676 patients.…”

Association of non-alcoholic fatty liver disease and polycystic ovarian syndrome

“…17 IR, obesity and oxidative stressors are reported by multiple studies as independent risk factors for inflammation and fibrosis development in patients with NAFLD. [18][19][20][21] Although there is growing evidence on an association between PCOS and NAFLD, as they share similar metabolic comorbidities, the question remains whether androgen excess is a confounding factor for the development of NAFLD, in addition to a shared metabolic dysfunction. A large study in the UK 22 evaluated 63 125 women to assess the risk factors for NAFLD in women with PCOS from 2000 until 2016.…”

Hypoxia and Non-alcoholic Fatty Liver Disease

“…Additional clinical studies and clinical trials have reinforced this notion, and their more relevant findings are summarized in Table 1. Notably, a study has demonstrated that OSA patients were three times more likely to have NASH compared with subjects without OSA (41). Moreover, clinical evidence suggests a direct relationship between OSA and NAFLD severity (42,45).…”