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Wang L, Liu H, Zhou L, Zheng P, Li H, Zhang H, Liu W. Association of Obstructive Sleep Apnea with Nonalcoholic Fatty Liver Disease: Evidence, Mechanism, and Treatment. Nat Sci Sleep 2024; 16:917-933. [PMID: 39006248 PMCID: PMC11244635 DOI: 10.2147/nss.s468420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024] Open
Abstract
Obstructive sleep apnea (OSA), a common sleep-disordered breathing condition, is characterized by intermittent hypoxia (IH) and sleep fragmentation and has been implicated in the pathogenesis and severity of nonalcoholic fatty liver disease (NAFLD). Abnormal molecular changes mediated by IH, such as high expression of hypoxia-inducible factors, are reportedly involved in abnormal pathophysiological states, including insulin resistance, abnormal lipid metabolism, cell death, and inflammation, which mediate the development of NAFLD. However, the relationship between IH and NAFLD remains to be fully elucidated. In this review, we discuss the clinical correlation between OSA and NAFLD, focusing on the molecular mechanisms of IH in NAFLD progression. We meticulously summarize clinical studies evaluating the therapeutic efficacy of continuous positive airway pressure treatment for NAFLD in OSA. Additionally, we compile potential molecular biomarkers for the co-occurrence of OSA and NAFLD. Finally, we discuss the current research progress and challenges in the field of OSA and NAFLD and propose future directions and prospects.
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Affiliation(s)
- Lingling Wang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ling Zhou
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Pengdou Zheng
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Hai Li
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Huojun Zhang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Wei Liu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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Garofalo E, Neri G, Perri LM, Lombardo N, Piazzetta G, Antonelli A, Biamonte E, Bosco V, Battaglia C, Pelaia C, Manti F, Pitino A, Tripepi G, Bruni A, Morelli M, Giudice A, Longhini F. Assessment of cephalometric parameters and correlation with the severity of the obstructive sleep apnea syndrome. J Transl Med 2024; 22:377. [PMID: 38649914 PMCID: PMC11036665 DOI: 10.1186/s12967-024-05194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In individuals diagnosed with obstructive sleep apnea syndrome (OSAS), variations in craniofacial structure have been inconsistently documented, showing differing degrees of alteration between obese and nonobese patients. In addition, sleep disturbance has also been shown to induce disequilibrium in this population of patients. This pilot observational study aimed to assess craniofacial values in obese and nonobese subpopulations of patients with OSAS and their correlation and association with the severity of OSAS. We also assessed whether OSAS patients are characterized by an impaired equilibrium in relation to and associated with the severity of OSAS. METHODS We included all consecutive adult patients with OSAS. Through cephalometry, we assessed the upper (UPa-UPp) and lower (LPa-LPp) pharynx diameters, superior anterior facial height (Sor-ANS), anterior facial height (ANS-Me), anterior vertical dimension (Sor-Me), posterior facial height (S-Go) and craniovertebral angle (CVA). Furthermore, we analyzed postural equilibrium through a stabilometric examination. RESULTS Forty consecutive OSAS patients (45% female with a mean age of 56 ± 8.2 years) were included. The subgroup of nonobese patients had a reduced UPa-UPp (p = 0.02). Cephalometric measurements were correlated with the severity of OSAS in nonobese patients, whereas only Sor-ANS was correlated with the severity of OSAS in the obese subpopulation. In the overall population, altered craniofacial values are associated with severe OSAS. Although there are differences in equilibrium between obese and nonobese OSAS patients, the stabilometric measurements were not correlated or associated with OSAS severity. CONCLUSION Altered craniofacial values and compromised equilibrium in OSAS patients are linked to OSAS severity. Therefore, the management of OSAS should be tailored not only to weight management but also to craniofacial and postural rehabilitation to enhance patient outcomes.
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Affiliation(s)
- Eugenio Garofalo
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Giuseppe Neri
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Lucilla Maria Perri
- Department of Health Sciences, School of Dentistry, Magna Graecia University, Catanzaro, Italy
| | - Nicola Lombardo
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Giovanna Piazzetta
- Department of Otolaryngology, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | - Alessandro Antonelli
- Department of Health Sciences, School of Dentistry, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Biamonte
- Department of Anesthesia and Intensive Care, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | - Vincenzo Bosco
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Caterina Battaglia
- Department of Radiology, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
| | - Francesco Manti
- Department of Radiology, "R. Dulbecco" University Hospital, Catanzaro, Italy
| | | | | | - Andrea Bruni
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy.
| | - Michele Morelli
- Department of Obstetrics and Gynecology, "Annunziata" Hospital, Cosenza, Italy
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, Magna Graecia University, Catanzaro, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europe, 88100, Catanzaro, Italy
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Hany M, Abouelnasr AA, Abdelkhalek MH, Ibrahim M, Aboelsoud MR, Hozien AI, Torensma B. Effects of obstructive sleep apnea on non-alcoholic fatty liver disease in patients with obesity: a systematic review. Int J Obes (Lond) 2023; 47:1200-1213. [PMID: 37696927 PMCID: PMC10663145 DOI: 10.1038/s41366-023-01378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Obesity has been linked to non-alcoholic fatty liver disease (NAFLD), a widespread chronic liver ailment, as well as obstructive sleep apnea (OSA). The development of NAFLD is influenced by repeated intermittent hypoxia, a feature of OSA. METHODS This systematic review (SR) investigated CENTRAL, PubMed, and EMBASE databases. The endpoint of this SR was to assess which OSA-related indicators could predict the presence of NAFLD and the effect of bariatric metabolic surgery (BMS) on improving OSA and NAFLD over time. RESULTS Compared to previous SRs published in 2013, 14 new publications were added to our SR, alongside studies conducted prior to 2013. The SR ultimately included 28 studies (18 cross-sectional and 10 cohort trials). In the majority of studies, significant correlations were observed between OSA, OSA-related outcomes, and NAFLD. However, the apnea-hypopnea index (AHI) alone proved to be an inadequate predictor of NAFLD. Instead, respiratory and metabolic changes were found to alleviate oxidative stress induced by hypoxemia. Six studies involved patients who underwent BMS, with one evaluating patients before and after BMS, revealing associations between increased OSA and NAFLD improvement following BMS. Six months after surgery, 100% of patients in the mild-to-moderate OSA group were free from fatty liver, and an 89% reduction was observed in the severe OSA group. CONCLUSION For the first time, BMS has been tested in treating both OSA and NAFLD pre and postoperative with positive results. Further research, ideally with histological and functional data, is needed to confirm these findings. The SR identified 14 distinct liver outcome tests; however, high heterogeneity and incomplete data precluded a meta-analysis. It is imperative to pay greater attention to the influence of OSA-related factors and uniformity in liver outcomes testing concerning NAFLD. To accomplish this, study designs should be enhanced by incorporating more comprehensive pre- and postoperative evaluations, extending follow-up periods, and employing a more consistent methodology for liver diagnosis in patients with obesity.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria Governorate, Egypt.
- Madina Women's Hospital (IFSO certified center, European chapter), Alexandria Governorate, Egypt.
| | - Anwar Ashraf Abouelnasr
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria Governorate, Egypt
| | | | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria Governorate, Egypt
| | - Mostafa R Aboelsoud
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria Governorate, Egypt
| | - Adel Ibrahim Hozien
- Department of Anesthesia and pain management, Medical Research Institute Alexandria University, Alexandria Governorate, Egypt
| | - Bart Torensma
- Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Rhynchophylline relieves nonalcoholic fatty liver disease by activating lipase and increasing energy metabolism. Int Immunopharmacol 2023; 117:109948. [PMID: 37012893 DOI: 10.1016/j.intimp.2023.109948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 03/13/2023]
Abstract
Hepatic fat metabolism may be altered in the context of overnutrition and obesity, often resulting in the accumulation of triglycerides in hepatocytes and leading to nonalcoholic fatty liver disease (NAFLD). Natural plant alkaloids have demonstrated great potential for the prevention and treatment of NAFLD. However, the role of rhynchophylline (RHY) in lipid metabolism is not clear. We explored the role of RHY in lipid metabolism in cells treated with oleic and palmitic acids to mimic high-fat diet (HFD) conditions. RHY attenuated oleic and palmitic acid-induced increases in triglyceride accumulation in HepG2, AML12, and LMH cells. RHY also increased energy metabolism and reduced oxidative stress. We further investigated the effect of RHY on hepatic lipid metabolism in mice fed an HFD including 40 mg/kg RHY. RHY alleviated hepatic steatosis, reduced fat deposition, promoted energy metabolism, and improved glucose metabolism. We investigated the mechanism responsible for this activity by docking with key proteins of lipid metabolism disorders using Discovery Studio software, which showed that RHY interacted well with lipases. Finally, we found that adding RHY promoted lipase activity and lipolysis. In conclusion, RHY ameliorated HFD-induced NAFLD and its complications by increasing lipase activity.
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Yu L, Lin C, Chen X, Teng Y, Zhou S, Liang Y. A Meta-Analysis of Sleep Disorders and Nonalcoholic Fatty Liver Disease: Potential Causality and Symptom Management. Gastroenterol Nurs 2022; 45:354-363. [PMID: 35913418 DOI: 10.1097/sga.0000000000000658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/29/2021] [Indexed: 01/10/2023] Open
Abstract
Nonalcoholic fatty liver disease is a type of metabolic disease, and recent research indicates that it may be associated with sleep disorders. We conducted a meta-analysis of current studies to estimate the associations between nonalcoholic fatty liver disease and sleep situation, including sleep duration, daytime sleepiness, and sleep disorder. This study follows the checklist of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Articles in the recent 10 years were searched from five databases. Eighteen articles, which met the eligibility criteria, were included in this meta-analysis. The results show that patients with nonalcoholic fatty liver disease have a shorter sleep duration and higher Epworth Sleepiness Scale score. Patients with short sleep duration (≤6 hours per night) or with obstructive sleep apnea have a higher risk of nonalcoholic fatty liver disease. In conclusion, there is a significant association between nonalcoholic fatty liver disease and sleep disorders in the included studies. In addition, patients with nonalcoholic fatty liver disease may have more severe daytime sleepiness and shorter sleep duration. More attention should be paid to the sleep situation of nonalcoholic fatty liver disease patients to potentially slow the disease progression.
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Affiliation(s)
- Lebing Yu
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
| | - Chenli Lin
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
| | - Xinhe Chen
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
| | - Yuxin Teng
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
| | - Shuang Zhou
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
| | - Yinji Liang
- Lebing Yu, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Chenli Lin, PhD, MD, is an associate professor, School of Medicine, Jinan University, Guangzhou, China
- Xinhe Chen, is BS MED candidate, School of Stomatology, Jinan University, Guangzhou, China
- Yuxin Teng, BSN, RN, is MPH candidate, School of Nursing, Jinan University, Guangzhou, China
- Shuang Zhou, BSN, RN, is MSN candidate, School of Nursing, Jinan University, Guangzhou, China
- Yinji Liang, PhD, MD, RN, is an associate professor, School of Nursing, Jinan University, Guangzhou, China
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Lian N, Wu J, Wang B, Lin S, Huang J, Chen J, Lin Q. Risk Factors of Nonalcoholic Fatty Liver Disease and Liver Fibrosis in Non-Obese Patients with Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:2143-2149. [PMID: 36507312 PMCID: PMC9733560 DOI: 10.2147/nss.s388203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/24/2022] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Liver injury in non-obese obstructive sleep apnea (OSA) patients has received much attention in recent years. This study aimed to investigate risk factors of nonalcoholic fatty liver disease (NAFLD) and liver fibrosis in non-obese patients with OSA. METHODS A retrospective study was conducted in the Sleep Center of the First Affiliated Hospital of Fujian Medical University. All consecutive non-obese patients with suspected sleep apnea admitted to the center were enrolled. The clinical characteristics of patients with simple snoring and with different severity OSA were compared. Multivariate logistic regression models were used to analyze the risk factors of NAFLD and liver fibrosis. RESULTS A total of 410 patients were enrolled. The levels of triglyceride, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increased with the aggravation of OSA (All p<0.05). Among non-obese patients with OSA, 17 (5%) were diagnosed with liver fibrosis and 228 (65%) with NAFLD; Apnea‑hyponea index (AHI) was an independent predictor for NAFLD and liver fibrosis [OR (95% CI): 1.02 (1.00-1.03), 1.04 (1.00-1.07), both p<0.05]; hypertriglyceridemia was an independent predictor for NAFLD [OR (95% CI): 1.13 (1.12-1.99), p<0.05]. CONCLUSION NAFLD and liver fibrosis were common in non-obese OSA patients and the severity of OSA was an independent risk factor for them.
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Affiliation(s)
- Ningfang Lian
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
| | - Jiawei Wu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
| | - Biying Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
| | - Su Lin
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Jiefeng Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
| | - Jia Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
| | - Qichang Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
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Shah NM, Malhotra AM, Kaltsakas G. Sleep disorder in patients with chronic liver disease: a narrative review. J Thorac Dis 2020; 12:S248-S260. [PMID: 33214928 PMCID: PMC7642630 DOI: 10.21037/jtd-cus-2020-012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sleep disturbance is a common feature of chronic liver disease (CLD) with impact on health-related quality of life; 60-80% of patients with CLD report subjective poor sleep; frequent presentations of sleep disturbance include insomnia, reduced sleep efficiency, increased sleep latency, reduced time in rapid eye movement (REM) sleep, restless leg syndrome and excessive daytime sleepiness (EDS). Key contributors to sleep disturbance include hepatic encephalopathy (HE) and circadian rhythm imbalance due to altered melatonin metabolism. Specific conditions causing CLD, such as non-alcoholic fatty liver disease (NAFLD), chronic viral hepatitis and primary biliary cholangitis (PBC) result in different types of sleep disturbance, and the treatment of these conditions can often also lead to sleep disturbance. There are currently limited management options for sleep disturbance in CLD. Obstructive sleep apnoea (OSA) is a common condition that causes chronic intermittent hypoxia due to airway collapse during sleep. This chronic intermittent hypoxia appears to contribute to the development of NAFLD. The presence of reactive oxygen species and the overexpression of hypoxia inducible factor 1-alpha secondary to hypoxia may be responsible for the second 'hit' of the 'two-hit' hypothesis of NAFLD. Treatment of the intermittent hypoxia with continuous positive airway pressure therapy has limited efficacy against liver dysfunction. There remain many outstanding areas of investigation in the management of sleep disturbance in CLD, and of liver dysfunction in OSA.
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Affiliation(s)
- Neeraj Mukesh Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Akanksha Mimi Malhotra
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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8
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Tepedino M, Illuzzi G, Laurenziello M, Perillo L, Taurino AM, Cassano M, Guida L, Burlon G, Ciavarella D. Craniofacial morphology in patients with obstructive sleep apnea: cephalometric evaluation. Braz J Otorhinolaryngol 2020; 88:228-234. [PMID: 32943377 PMCID: PMC9422716 DOI: 10.1016/j.bjorl.2020.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/19/2020] [Accepted: 05/31/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Obstructive sleep apnea is characterized by a reduced airflow through the upper airways during sleep. Two forms of obstructive sleep apnea are described: the central form and the obstructive form. The obstructive form is related to many factors, such as the craniofacial morphology. Objective To evaluate the correlation between the morphology of the cranial base, of the mandible and the maxilla, and obstructive sleep apnea severity. Methods Eighty-four patients, mean age of 50.4 years old; 73 males and 11 females with obstructive sleep apnea were enrolled in the present study. Patients with high body mass index and comorbidities were excluded. Lateral cephalograms and polysomnography were collected for each patient to evaluate the correlation between craniofacial morphology and obstructive sleep apnea severity. A Spearman’s rho correlation test between cephalometric measurements and obstructive sleep apnea indexes was computed. Statistical significance was set at p < 0.05. Results Patients with a severe obstructive sleep apnea presented a reduction of sagittal growth of both effective mandibular length and cranio-basal length. The mandibular length was the only variable with a statistical correlation with apnea-hypopnea index. Vertical dimension showed a weak correlation with the severity of obstructive sleep apnea. No correlation with maxillary sagittal dimension was shown. Conclusion Obstructive sleep apnea severity may be correlated to mandibular and cranial base growth. Facial vertical dimension had no correlation with obstructive sleep apnea severity.
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Affiliation(s)
- Michele Tepedino
- University of L'Aquila, Department of Biotechnological and Applied Clinical Sciences, L'Aquila, Italy
| | - Gaetano Illuzzi
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Michele Laurenziello
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy.
| | - Letizia Perillo
- Second University of Naples, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Naples, Italy
| | - Anna Maria Taurino
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Michele Cassano
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Laura Guida
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Giuseppe Burlon
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
| | - Domenico Ciavarella
- University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy
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Extra-hepatic manifestations and complications of nonalcoholic fatty liver disease. Future Med Chem 2020; 11:2171-2192. [PMID: 31538528 DOI: 10.4155/fmc-2019-0003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This review article aims to synthesize the evidence regarding nonalcoholic fatty liver disease (NAFLD) as a systemic disorder. We critically discuss the metabolic syndrome and its components; the cardiovascular and the endocrine system; chronic respiratory disorders; the musculoskeletal system; the skin; and extra-hepatic tumors. We conclude that, while some of these extra-hepatic conditions clearly predispose to the development of secondary forms of NAFLD (typically hypothyroidism-induced NAFLD), others result from pre-existent NAFLD (e.g., certain extra-hepatic tumors) and others (such as Type 2 Diabetes) have, with NAFLD, mutual and bidirectional associations. Analyzed data imply that NAFLD is not merely a hepatic disease. It is also and possibly more importantly, a systemic disorder requiring a special awareness, a multidisciplinary approach and a multidimensional vision.
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Chronic intermittent hypoxia in obstructive sleep apnea: a narrative review from pathophysiological pathways to a precision clinical approach. Sleep Breath 2019; 24:751-760. [DOI: 10.1007/s11325-019-01967-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/07/2019] [Accepted: 10/24/2019] [Indexed: 12/25/2022]
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Do T90 and SaO2 nadir identify a different phenotype in obstructive sleep apnea? Sleep Breath 2019; 23:1007-1010. [DOI: 10.1007/s11325-019-01860-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 02/06/2023]
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Abstract
Nonalcoholic fatty liver disease (NAFLD), a disorder of altered metabolic pathways, is increasing worldwide. Recent studies established obstructive sleep apnea (OSA) and chronic intermittent hypoxia (CIH) as NAFLD risk factors. Studies have ascertained that CIH is independently related to NAFLD. Continuous positive airway pressure (CPAP) shows inconsistent results regarding its efficacy in improving NAFLD. Observational, longer duration CPAP therapy studies have shown positive outcomes, whereas shorter duration, randomized controlled trials have shown no benefit. A multifaceted approach to NAFLD management with sufficiently longer duration of CPAP therapy may be beneficial in patients with moderate to severe OSA.
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Affiliation(s)
- Malav P Parikh
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, M2 Annex, Cleveland, OH 44114, USA
| | - Niyati M Gupta
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, M2 Annex, Cleveland, OH 44114, USA
| | - Arthur J McCullough
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, M2 Annex, Cleveland, OH 44114, USA; Department of Inflammation and Immunity, Cleveland Clinic Lerner College of Medicine, Case Western University, Cleveland, OH 44195, USA.
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