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Obstructive sleep apnea linked to NASH, other liver conditions

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Obstructive sleep apnea is associated with nonalcoholic steatohepatitis, steatosis, lobular inflammation and advanced stages of fibrosis, according to findings presented at Obesity Week 2014.

Further investigation is needed to assess the relationships of obstructive sleep apnea (OSA) defined by polysomnography and nonalcoholic steatohepatitis (NASH), according to researchers.

“OSA is associated with elevated aminotransferase levels, hepatic steatosis, inflammation and fibrosis, and the presence of NASH,” according to a presentation by Kathleen E. Corey, MD, MPH, of Massachusetts General Hospital.

Kathleen E. Corey

From 2010 to 2013, Corey and colleagues studied 213 adults consecutively enrolled for Roux-en-Y gastric bypass or sleeve gastrectomy for weight loss to determine the presence of OSA and assess liver histology. OSA was defined by patient report of positive sleep study or patient use of continuous positive airway pressure.

Patients with OSA (n=112) tended to be older (51 years vs. 43.8 years), male (29.5% vs. 5%), white (75% vs. 55.5%), and more often had diabetes (49.6% vs. 18.2%) than those without OSA (n=101; P<.0001 for all), according to the researchers.

They compared liver histology between groups. Nonalcoholic fatty liver disease (NAFLD) was defined by the presence of at least grade 1 steatosis not meeting criteria for NASH; NASH was defined as lobular inflammation, hepatocyte ballooning and steatosis of at least grade 1; and advanced fibrosis was defined as stage 3 to 4 fibrosis.

Multivariable regression modeling was used to evaluate the independent association of OSA with liver histology; variables demonstrating significance on univariate analysis were used in multivariate analysis.

OSA was associated with NASH; the relationship remained after adjusting for age, sex, race and diabetes (OR=2.01; P=.03). Based on multivariable analysis, OSA was associated with steatosis (OR=2.3; P=.004), lobular inflammation (OR=2.06; P=.02) and fibrosis (OR=2.01; P=.04). Advanced fibrosis was observed only in patients with OSA.

Aminotransferase levels were higher in patients with OSA vs. without. Researchers showed significant differences in alanine transaminase (54.1 U/L vs. 37.7 U/L; P<.001), aspartate aminotransferase (31.7 U/L vs. 20.5 U/L; P<.001) and total bilirubin (0.51 U/L vs. 0.43 U/L; P=.006).

“Further studies are needed to evaluate the impact of OSA treatment on NASH,” according to researchers.

For more information:

Corey K. Abstract T-3091-OR. Presented at: Obesity Week; Nov. 2-7, 2014; Boston.

Disclosure: Corey reports speaking for Gilead, Intercept and Synageva. The research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Heart, Lung, and Blood Institute.