title: Nonalcoholic steatohepatitis in bariatric patients with a diagnosis of obstructive sleep apnea.
abstract: OBJECTIVE
  To study a possible association between obstructive sleep apnea (OSA) severity, managed with noninvasive ventilation, and nonalcoholic steatohepatitis (NASH) in bariatric surgical patients.
  
  
  METHODS
  Medical records of 218 bariatric surgical patients who underwent liver biopsy were reviewed. OSA severity was determined from preoperative polysomnography (apnea-hypopnea index (AHI) ≤ 15 no/mild OSA vs. AHI ≥ 16 moderate/severe OSA). Patients diagnosed with OSA were prescribed noninvasive ventilation. Patients were categorized according to liver histopathology into 3 groups: (i) no liver disease or simple steatosis, (ii) mild NASH (steatosis with necroinflammation and mild fibrosis (stage 0-1)), and iii) advanced NASH (steatosis with necroinflammation and more advanced fibrosis (stage ≥ 2)).
  
  
  RESULTS
  125 patients (57%) had no/mild OSA, and 93 (43%) had moderate/severe OSA. There was no difference in serum aminotransferases between patients by OSA severity classification. There was a high prevalence of hepatic histopathological abnormalities: 84% patients had steatosis, 57% had necroinflammation, 34% had fibrotic changes, and 14% had advanced NASH. There was no association between severity of NASH and severity of OSA.
  
  
  CONCLUSIONS
  There is no association between stage of steatohepatitis and OSA severity among morbidly obese patients managed with noninvasive ventilation.
authors.affiliation: Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.forename: Carlos B
authors.initials: CB
authors.lastname: Mantilla
authors.forename: James M
authors.initials: JM
authors.lastname: Swain
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Oberhansley
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Burcham
authors.forename: Tarsila C R
authors.initials: TC
authors.lastname: Ribeiro
authors.forename: Kymberly D
authors.initials: KD
authors.lastname: Watt
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: Bradly J
authors.initials: BJ
authors.lastname: Narr
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D005234:Fatty Liver / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000453:epidemiology; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D009767:Obesity, Morbid / Q000601:surgery*; D017286:Polysomnography; D015995:Prevalence; D012016:Reference Values; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D000637:Transaminases / Q000097:blood
chemical_list: D000637:Transaminases