title: Obstructive Sleep Apnea Is Associated with Liver Damage and Atherosclerosis in Patients with Non-Alcoholic Fatty Liver Disease.
abstract: OBJECTIVE
  We assessed whether obstructive sleep apnea (OSA) and nocturnal hypoxemia are associated with severity of liver fibrosis and carotid atherosclerosis in patients with biopsy-proven NAFLD and low prevalence of morbid obesity. Secondary aim was to explore the association of OSA and hypoxemia with NASH and severity of liver pathological changes.
  
  
  METHODS
  Consecutive patients (n = 126) with chronically elevated ALT and NAFLD underwent STOP-BANG questionnaire to estimate OSA risk and ultrasonographic carotid assessment. In patients accepting to perform cardiorespiratory polygraphy (PG, n = 50), OSA was defined as an apnea/hypopnea index ≥5. A carotid atherosclerotic plaque was defined as a focal thickening >1.3 mm.
  
  
  RESULTS
  Prevalence of high OSA risk was similar in patients refusing or accepting PG (76% vs 68%, p = 0.17). Among those accepting PG, overall OSA prevalence was significantly higher in patients with F2-F4 fibrosis compared to those without (72% vs 44%; p = 0.04). Significant fibrosis was independently associated with mean nocturnal oxygen saturation (SaO2)<95% (OR 3.21, 95%C.I. 1.02-7.34; p = 0.04). Prevalence of OSA tended to be higher in patients with, than in those without, carotid plaques (64% vs 40%; p = 0.08). Carotid plaques were independently associated with %time at SaO2<90% >1 (OR 6.30, 95%C.I. 1.02-12.3; p = 0.01).
  
  
  CONCLUSIONS
  In NAFLD patients with chronically elevated ALT at low prevalence of morbid obesity, OSA was highly prevalent and indexes of SaO2 resulted independently associated with severity of liver fibrosis and carotid atherosclerosis. These data suggest to consider sleep disordered breathing as a potential additional therapeutic target in severe NAFLD patients.
authors.affiliation: Sezione di Gastroenterologia e Epatologia, DiBiMIS, University of Palermo, Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
authors.affiliation: National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy.
authors.forename: Oreste
authors.initials: O
authors.lastname: Marrone
authors.affiliation: Sezione di Medicina Interna, DiBiMIS, University of Palermo, Palermo, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Torres
authors.affiliation: Sezione di Malattie Cardio Respiratorie ed Endocrino Metaboliche, DiBiMIS, University of Palermo, Palermo, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Buttacavoli
authors.affiliation: Sezione di Gastroenterologia e Epatologia, DiBiMIS, University of Palermo, Palermo, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Cammà
authors.affiliation: Sezione di Gastroenterologia e Epatologia, DiBiMIS, University of Palermo, Palermo, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Di Marco
authors.affiliation: Sezione di Gastroenterologia e Epatologia, DiBiMIS, University of Palermo, Palermo, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Licata
authors.affiliation: National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Lo Bue
authors.affiliation: Sezione di Medicina Interna, DiBiMIS, University of Palermo, Palermo, Italy.
authors.forename: Gaspare
authors.initials: G
authors.lastname: Parrinello
authors.affiliation: Sezione di Medicina Interna, DiBiMIS, University of Palermo, Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
authors.affiliation: National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Salvaggio
authors.affiliation: Sezione di Medicina Interna, DiBiMIS, University of Palermo, Palermo, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Tuttolomondo
authors.affiliation: Sezione di Gastroenterologia e Epatologia, DiBiMIS, University of Palermo, Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
authors.affiliation: Sezione di Malattie Cardio Respiratorie ed Endocrino Metaboliche, DiBiMIS, University of Palermo, Palermo, Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Bonsignore
mesh_terms: D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D001706:Biopsy; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000453:epidemiology; D058226:Plaque, Atherosclerotic / Q000378:metabolism / Q000473:pathology; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D011795:Surveys and Questionnaires