Can the Apnea-Hypopnea Index Be a Marker of Liver Fibrosis in Patients with Obstructive Sleep Apnea?

Abstract

Objective: The aim of this study; to examine the relationship between hepatosteatosis, non-alcoholic steatohepatitis (NASH) and hepatic fibrosis and the severity of obstructive sleep apnea syndrome (OSAS). Materials and Methods: Our study included 120 patients who underwent polysomnography in the otorhinolaryngology outpatient clinic between January 2021 and January 2022, and who had previously undergone liver biopsy under ultrasonography (USG) guidance. Patients with simple snoring with apnea-hypopnea index (AHI) <5 were taken as the control group. Patients with alcohol use, viral hepatitis and other chronic liver diseases were excluded. All patients were evaluated by USG and liver biopsy. The relationship between hepatosteatosis, NASH and fibrosis with AHI, oxygen desaturation index (ODI) and minimum pO2 (min-pO2) were examined. Results: The presence of steatohepatitis, NASH, and fibrosis was higher in the OSAS group than in the control group (p<0.05). The presence of NASH and fibrosis was higher in the severe OSAS group than in all other groups (p<0.05). There was a strong positive linear relationship between AHI with hepatosteatosis and NASH, and a very strong positive linear relationship with fibrosis (p<0.001). When the distinction between fibrosis negative and fibrozis positive patients for these variables were compared, the performance of AHI [0.959 (0.907-0.987)] was compared with that of ODI [0.843 (0.766-0.903)] and min-pO2 performance [0.804 (0.722-0.871)], AHI was found to be significantly higher (p<0.05). Conclusion: The performance of the AHI was higher than the ODI and min-pO2 in distinction between fibrosis (-) and fibrozis (+) patients and NASH (-) and NASH (+) patients.

Keywords

• apnea-hypopnea index
• fibrosis
• obstructive sleep apnea
• nonalcoholic fatty liver disease