Obstructive Sleep Apnea and Non-alcoholic Fatty Liver Disease in Obese Patients Undergoing Bariatric Surgery
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ORIGINAL CONTRIBUTIONS
Obstructive Sleep Apnea and Non-alcoholic Fatty Liver Disease in Obese Patients Undergoing Bariatric Surgery Katherine J. P. Schwenger 1,2 & Yasaman Ghorbani 1,2 & Carrie Li 2 & Sandra E. Fischer 2,3 & Timothy D. Jackson 4,5 & Allan Okrainec 4,5 & Johane P. Allard 2,6,7,8
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Morbid obesity is associated with multiple comorbidities including obstructive sleep apnea (OSA) and nonalcoholic fatty liver disease (NAFLD). It has been suggested that OSA may contribute to NAFLD pathogenesis due to intermittent nocturnal hypoxia. Purpose The objective of this study was to assess the apnea-hypopnea index (AHI) and lower minimum oxygen saturation, markers of OSA, in patients undergoing bariatric surgery (BSx) with perioperative liver biopsy to detect NAFLD. Methods This was a single center cross-sectional study of 61 patients undergoing BSx who consented to have a perioperative wedged liver biopsy. Biochemical, clinical, anthropometric variables, and a sleep study test were performed prior to BSx. Results NAFLD was diagnosed in 49 (80.3%) patients; 12 had normal liver (NL). Those with NAFLD had significantly higher (p < 0.05) AST (42.6 vs 18.1 U/L) and ALT (35.0 vs 22.1 U/L) but similar clinical, anthropometric, and metabolic parameters to NL. There was a higher AHI (32.03 vs 14.35) and significantly lower minimum oxygen saturation (SaO2) (78.87 vs 85.63) in NAFLD compared with NL (p < 0.05). When assessing associations between OSA parameters and liver histology in NAFLD, AHI correlated significantly with lobular inflammation (p < 0.05). In a multivariate analysis, BMI was significantly correlated with lobular inflammation with mean SaO2 nearing significance. Conclusions These results indicate that in a homogeneous bariatric population sample with similar characteristics, those with NAFLD had higher AHI and lower minimum SaO2 compared with NL. AHI correlated with liver inflammation suggesting a potential role for intermittent nocturnal hypoxia in the pathogenesis and progression of NAFLD. Keywords Non-alcoholic fatty liver disease . Obstructive sleep apnea . Bariatric surgery . Obesity
* Johane P. Allard [email protected] 1
Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
2
Toronto General Hospital, University Health Network, Toronto, Canada
3
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
4
Division of General Surgery, University of Toronto, Toronto, Canada
5
Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Canada
6
Department of Medicine, University of Toronto, Toronto, Canada
7
Department of Nutritional Sciences, University of Toronto, Toronto, Canada
8
Department of Medicine, Division of Gastroenterology, Toronto General Hospital, 585 University Avenue, 9N-973, Toronto, Ontario M5G 2C4, Canada
Introduction Non-alcoholic fatty liver disease (NAFLD) is one of the most common caus
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