title: Association Between the Severity of Nocturnal Hypoxia in Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Damage.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is a major disease that can cause significant mortality and morbidity. Chronic intermittent hypoxia is a potential causal factor in the progression from fatty liver to nonalcoholic steatohepatitis.
  
  
  OBJECTIVE
  This study evaluated the association between the degree of liver steatosis and severity of nocturnal hypoxia.
  
  
  METHODS
  In this study, between December 2011 and December 2013, patients with ultrasound-diagnosed NAFLD evaluated by standart polysomnography were subsequentally recorded. Patients with alcohol use, viral hepatitis and other chronic liver diseases were excluded. We analyzed polysomnographic parameters, steatosis level and severity of obstructive sleep apnea (OSA) in consideration of body mass index (BMI), biochemical tests and ultrasonographic liver data of 137 subjects. Patients with sleep apnea and AHI scores of < 5, 5 - 14, 15 - 29 and ≥30 are categorized as control, mild, moderate and severe, respectively.
  
  
  RESULTS
  One hundred and thirty-seven patients (76 women, 61 men) with a mean age of 55.75 ± 10.13 years who underwent polysomnography were included in the study. Of 118 patients diagnosed with OSA, 19 (16.1%) had mild OSA, 39 (33.1%) moderate OSA and 60 (50.8%) severe OSA. Nineteen cases formed the control group. Apnea/hypopnea index and oxygen desaturation index (ODI) values were significantly higher in moderate and severe non-alcoholic fatty liver disease (NAFLD) compared to the non-NAFLD group. Mean nocturnal SpO2 values were significantly lower in mild NAFLD and severe NAFLD compared to the non-NAFLD group. Lowest O2 saturation (LaSO2) was found low in mild, moderate and severe NAFLD compared to the non-NAFLD group in a statistically significant manner.
  
  
  CONCLUSIONS
  We assessed polysomnographic parameters of AHI, ODI, LaSO2 and mean nocturnal SpO2 levels, which are especially important in the association between NAFLD and OSAS. We think that it is necessary to be attentive regarding NAFLD development and progression in patients with OSA whose nocturnal hypoxia is severe.
authors.affiliation: Department of Gastroenterology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
authors.forename: Erol
authors.initials: E
authors.lastname: Cakmak
authors.affiliation: Department of Chest Diseases, Sivas Numune Hospital, Sivas, Turkey.
authors.forename: Faysal
authors.initials: F
authors.lastname: Duksal
authors.affiliation: Department of Gastroenterology, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Engin
authors.initials: E
authors.lastname: Altinkaya
authors.affiliation: Department of Endocrinology, Sivas Numune Hospital, Sivas, Turkey.
authors.forename: Fettah
authors.initials: F
authors.lastname: Acibucu
authors.affiliation: Department of Chest Diseases, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
authors.forename: Omer Tamer
authors.initials: OT
authors.lastname: Dogan
authors.affiliation: Department of Gastroenterology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Yonem
authors.affiliation: Department of Gastroenterology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
authors.forename: Abdulkerim
authors.initials: A
authors.lastname: Yilmaz
keywords: Hypoxia; Non-Alcoholic Fatty Liver Disease; Obstructive; Sleep Apnea
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