The Relationship Between Chronic Intermittent Hypoxia and MASLD and Fibrosis in Obstructive Sleep Apnea Patients

Area of Science:

• Hepatology
• Pulmonology
• Metabolic Disorders

Background:

• Obstructive sleep apnea (OSA) involves recurrent breathing interruptions and oxygen drops during sleep.
• Chronic intermittent hypoxia (CIH) from OSA may contribute to metabolic dysfunction-associated steatotic liver disease (MASLD) and liver fibrosis.
• The study investigates the link between OSA severity, hypoxemia, and MASLD/fibrosis.

Purpose of the Study:

• To evaluate the association between OSA severity and hypoxemia indices with MASLD and liver fibrosis.
• To identify independent predictors of MASLD and fibrosis in patients evaluated for OSA.
• To inform clinical practice regarding liver assessment in OSA patients.

Main Methods:

• Prospective enrollment of 400 adults suspected of having OSA.
• Overnight polysomnography to record apnea-hypopnea index (AHI) and oxygen desaturation index (ODI).
• Transient elastography (FibroScan) to assess MASLD (CAP) and fibrosis (LSM).

Main Results:

• MASLD prevalence was 76%, and fibrosis prevalence was 34.5%.
• Patients with fibrosis showed higher AHI, ODI, and lower minimum SpO2.
• Multivariable analysis revealed BMI and metabolic syndrome as independent predictors for both MASLD and fibrosis.

Conclusions:

• Initial associations between OSA severity/hypoxemia and liver disease were observed.
• Obesity (BMI) and metabolic syndrome independently predict MASLD and fibrosis in OSA patients.
• Liver assessment is recommended for OSA patients, especially those with high BMI and metabolic syndrome.