title: Obstructive sleep apnea and hypoxemia are associated with advanced liver histology in pediatric nonalcoholic fatty liver disease.
abstract: OBJECTIVE
  To determine whether obstructive sleep apnea (OSA) and/or nocturnal hypoxemia are associated with the severity of liver injury in patients with pediatric nonalcoholic fatty liver disease (NAFLD).
  
  
  METHODS
  Obese children aged 10-18 years with liver biopsy-proven NAFLD were enrolled. Demographic, clinical, and laboratory data were collected, polysomnography was performed, and liver histology was scored. Subjects were divided into those with OSA/hypoxemia and those without OSA/hypoxemia for analysis.
  
  
  RESULTS
  Of 25 subjects with NAFLD, OSA/hypoxemia was present in 15 (60%) (mean age, 12.8 ± 1.9 years; 68% male; 88% Hispanic; mean body mass index z-score, 2.3 ± 0.3). Subjects with and without OSA/hypoxemia had similar levels of serum aminotransferases, serum lipids, and inflammatory and insulin resistance markers. Although there were no differences between groups in the histological severity of steatosis, inflammation, ballooning degeneration, NAFLD activity score, or histological grade, subjects with OSA/hypoxemia had significantly more severe hepatic fibrosis. Moreover, oxygen saturation nadir during polysomnography was related to hepatic fibrosis stage (r = -0.49; P = .01) and aspartate aminotransferase level (r = 0.42; P < .05). Increasing percentage of time with oxygen saturation ≤90% was related to NAFLD inflammation grade (r = 0.44; P = .03), degree of hepatic steatosis (r = -0.50; P = .01), NAFLD activity score (r = 0.42; P = .04), aspartate aminotransferase level (r = 0.56; P = .004), and alanine aminotransferase level (r = 0.44; P = .03).
  
  
  CONCLUSIONS
  Moderate OSA/hypoxemia is common in pediatric patients with biopsy-proven NAFLD. OSA and the severity/duration of hypoxemia are associated with biochemical and histological measures of NAFLD severity.
authors: Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics and the Digestive Health Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO. Electronic address: shikha.sundaram@childrenscolorado.org.
authors: Shikha S
authors: SS
authors: Sundaram
authors: Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics and the Digestive Health Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO.
authors: Ronald J
authors: RJ
authors: Sokol
authors: Department of Pathology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO.
authors: Kelley E
authors: KE
authors: Capocelli
authors: Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO.
authors: Zhaoxing
authors: Z
authors: Pan
authors: Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics and the Digestive Health Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO.
authors: Jillian S
authors: JS
authors: Sullivan
authors: Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics and the Digestive Health Institute, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO.
authors: Kristen
authors: K
authors: Robbins
authors: Pulmonary Section, Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO.
authors: Ann C
authors: AC
authors: Halbower
mesh_terms: D000293:Adolescent; D002648:Child; D005234:Fatty Liver / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000150:complications*; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000209:etiology*