Screening for Obstructive Sleep Apnea

Researchers examined liver injury in non-obese patients with obstructive sleep apnea (OSA), particularly their risk of nonalcoholic fatty liver disease (NAFLD) and liver fibrosis. Based on their retrospective analysis, the investigators suggested both NAFLD and liver fibrosis were common in non-obese patients with OSA, and that the apnea-hypopnea index (AHI) was an independent risk factor for liver injury.

The study, published in Nature and Science of Sleep, retrospectively enrolled 410 consecutive non-obese patients with suspected sleep apnea admitted to the authors’ center. Researchers compared clinical characteristics between patients with normal snoring and those with different severities of OSA. The authors used multivariate logistic regression models to identify independent risk factors for NAFLD and liver fibrosis.

Sleep Apnea Associated With Liver Injury in Non-Obese Patients

Reportedly, levels of triglyceride, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) all increased with increasing OSA severity (all P<.05). Among the cohort, 17 (5%) and 228 (65%) patients were diagnosed with liver fibrosis and NAFLD, respectively.

Of note, the authors’ multivariate analyses established that AHI was an independent predictor for both NAFLD (odds ratio [OR], 1.02; 95% CI, 1.00-1.03; P<.05) and liver fibrosis (OR, 1.04; 95% CI, 1.00-1.07; P<.05). Additionally, the authors reported that hypertriglyceridemia was an independent predictive factor for NAFLD alone (OR, 1.13; 95% CI, 1.12-1.99; P<.05).

The authors acknowledged their findings were inherently limited by the retrospective design of the study, and the fact that NAFLD, liver injury, and liver fibrosis were diagnosed with non-invasive methods, which may affect the reliability of the results.

Overall, the authors suggested that livery injury was common in non-obese patients w ith OSA. “Intense monitoring and evaluation of liver function in non-obese patients with severe OSA should be considered,” they suggested.

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