title: Obstructive Sleep Apnea Is Associated with Nonalcoholic Steatohepatitis and Advanced Liver Histology.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA) are growing in prevalence in the USA. Existing data on the relationship between OSA and NAFLD are conflicting and limited by the use of various histologic definitions of nonalcoholic steatohepatitis (NASH). Using a robust definition of NASH in a large, well-characterized cohort, we sought to evaluate whether OSA was associated with NASH and advanced fibrosis.
  
  
  METHODS
  Two hundred and thirteen subjects undergoing weight loss surgery were queried for OSA and then underwent liver biopsy. NASH was defined, as recommended by the American Association for the Study of Liver Disease, by the presence of all of the following: >5 % macrovesicular steatosis, lobular inflammation, and hepatocyte ballooning. NAFLD activity score (NAS) was also determined for each subject.
  
  
  RESULTS
  Subjects with OSA had significantly higher alanine and aspartate aminotransferase levels than subjects without OSA (ALT 54.1 vs. 37.7 U/L, P = 0.0007; AST 31.7 vs. 20.5 U/L, P = 0.0007). OSA was associated with the presence of NASH, and this remained significant after adjusting for age, gender, race, and diabetes mellitus (P = 0.03 OR 2.01; 95 %, 1.05-3.87). Steatosis grade, lobular inflammation grade, NAS score, and fibrosis stage were all significantly associated with the presence of OSA and remained so after adjustment.
  
  
  CONCLUSIONS
  OSA is associated with elevated aminotransferase levels, the presence of NASH, and advanced NASH histology. Further studies are needed to evaluate the impact of OSA treatment on NASH.
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Warren 1007, 55 Fruit Street, Boston, MA, 02114, USA, kcorey@partners.org.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Corey
authors.forename: Joseph
authors.initials: J
authors.lastname: Misdraji
authors.forename: Lou
authors.initials: L
authors.lastname: Gelrud
authors.forename: Lindsay Y
authors.initials: LY
authors.lastname: King
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Chung
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015897:Comorbidity; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000453:epidemiology* / Q000473:pathology
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
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