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Chronic liver injury during obstructive sleep apnea
Florence Tanné1, Frédéric Gagnadoux, Olivier Chazouillères
1Service d'Hépatologie, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France.
Hepatology (Baltimore, Md.)
|May 26, 2005
Summary
Severe obstructive sleep apnea (OSA) is a significant risk factor for fatty liver disease and elevated liver enzymes, even in non-obese individuals. Insulin resistance likely plays a key role in this liver damage.
Area of Science:
- Hepatology
- Sleep Medicine
- Internal Medicine
Background:
- Obstructive sleep apnea (OSA) is linked to obesity and fatty liver disease.
- Emerging evidence suggests OSA itself may directly cause liver injury.
- OSA is an independent risk factor for insulin resistance.
Purpose of the Study:
- To investigate liver damage and its mechanisms in non-drinking patients with suspected OSA.
- To determine if severe OSA is an independent risk factor for liver enzyme elevation and steatohepatitis.
Main Methods:
- 163 patients with suspected OSA underwent polysomnography.
- Serum liver enzymes were measured; liver biopsy was performed for elevated enzymes.
- Intrahepatic hypoxia assessed via VEGF expression; insulin resistance measured by HOMA.
Main Results:
- Severe OSA (AHI > 50/hr) found in 27% of patients.
- 20% of patients had elevated liver enzymes, associated with severe OSA and BMI.
- Severe OSA patients showed more steatohepatitis, fibrosis, and insulin resistance, independent of BMI.
Conclusions:
- Severe OSA is an independent risk factor for elevated liver enzymes and steatohepatitis.
- Insulin resistance is a probable mechanism linking severe OSA to liver damage.
- Further research is needed to clarify the role of hypoxia in OSA-related liver injury.