The association of nonalcoholic steatohepatitis and obstructive sleep apnea
Open accessAbstract
BACKGROUND AND AIM: The association between obstructive sleep apnea (OSA) and abnormal liver enzymes has been reported in multiple studies. The existing literature regarding the relationship between OSA and nonalcoholic steatohepatitis (NASH) is conflicting. Thus we aimed to determine the relationship between OSA and NASH from a large database. PATIENTS AND METHODS: A cross-sectional study was performed using the 2012 Nationwide Inpatient Sample. We identified adult patients (18-90 years) who had a diagnosis of OSA using the International Classification of Diseases 9th version codes. The control group was comprised of adult individuals with no discharge records of OSA. NASH diagnosis was also identified using the International Classification of Diseases 9th version codes. The association between OSA and NASH was calculated using univariable and multivariable logistic regression. RESULTS: A total of 30 712 524 hospitalizations were included. The OSA group included 1 490 150 patients versus 29 222 374 in the control non-OSA group. The OSA group average age was 61.8±0.07 years (44.2% females) compared with 57.0±0.11 years (60.1% females) in the non-OSA group. NASH prevalence was significantly higher in the OSA group compared with the non-OSA group [2% (95% confidence interval (CI): 1.9, 2.1) vs. 0.65% (95% CI: 0.63, 0.66), P<0.001]. After adjusting for obesity, diabetes, hypertension, dyslipidemia, the metabolic syndrome and Charlson comorbidity index, OSA patients were three times more likely to have NASH [adjusted odds ratio: 3.1 (95% CI: 3.0-3.3), P<0.001]. CONCLUSION: Patients with OSA are three times more likely to have NASH compared with patients without OSA after controlling for other confounders. These data indicate that OSA should be considered as an independent risk factor for developing NASH.
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Several studies suggest OSA is associated with more advanced MASLD/MASH histology.
“and several studies suggest OSA is also associated with more advanced MASLD/MASH histology, 64,65”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [64]
The Results (Multivariable Comparison) find that patients with OSA were more likely to have NASH, supporting an association with the more serious form of fatty liver disease. But the Discussion says this study could not assess whether OSA was associated with NASH severity; its diagnosis-code data do not establish more advanced histology. (LLM, conf=0.87)
Experimental — accuracy not yet measuredBoth OSA and PCOS are associated with MASLD.
“Both OSA and PCOS are associated with MASLD,”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [64]
The Results (Multivariable Comparison; page unavailable) report an association between OSA and NASH, a form of fatty liver disease. The paper does not address PCOS, and its finding concerns NASH rather than MASLD as a whole. (LLM, conf=0.88)
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- Authors
- Asfari, M. M., Niyazi, F., Lopez, R., Dasarathy, S., & McCullough, A. J.
- Affiliations
- Internal Medicine
- Quantitative Health Sciences, Cleveland Clinic
- Cleveland Clinic (US)
- Corresponding author
- Asfari, Mohammad M.
- Venue
- European Journal of Gastroenterology & Hepatology
- Published
- 2017-12
- Volume
- 29
- Issue
- 12
- Pages
- 1380-1384
- ISSN
- 0954-691X (ISSN-L)
- PMC
- PMC5675792
- OpenAlex
- W2754110647
- Cited by
- 25
- References
- 28
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 6 · 2019: 3
- FWCI
- 1.82
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- European Journal of Gastroenterology & Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK061732)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- obstructive sleep apnea, nonalcoholic steatohepatitis, metabolic syndrome, obesity, diabetes mellitus, comorbidities, hospitalization data
- MeSH terms
- Adolescent, Adult, Aged, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Risk Factors, United States, Prevalence, Case-Control Studies, Databases, Factual, Sleep Apnea, Obstructive, Young Adult, Non-alcoholic Fatty Liver Disease
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