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Obstructive Sleep Apnea and Non-alcoholic Fatty Liver Disease in Obese Patients Undergoing Bariatric Surgery

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Abstract

Background

Morbid obesity is associated with multiple comorbidities including obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD). It has been suggested that OSA may contribute to NAFLD pathogenesis due to intermittent nocturnal hypoxia.

Purpose

The objective of this study was to assess the apnea-hypopnea index (AHI) and lower minimum oxygen saturation, markers of OSA, in patients undergoing bariatric surgery (BSx) with perioperative liver biopsy to detect NAFLD.

Methods

This was a single center cross-sectional study of 61 patients undergoing BSx who consented to have a perioperative wedged liver biopsy. Biochemical, clinical, anthropometric variables, and a sleep study test were performed prior to BSx.

Results

NAFLD was diagnosed in 49 (80.3%) patients; 12 had normal liver (NL). Those with NAFLD had significantly higher (p < 0.05) AST (42.6 vs 18.1 U/L) and ALT (35.0 vs 22.1 U/L) but similar clinical, anthropometric, and metabolic parameters to NL. There was a higher AHI (32.03 vs 14.35) and significantly lower minimum oxygen saturation (SaO2) (78.87 vs 85.63) in NAFLD compared with NL (p < 0.05). When assessing associations between OSA parameters and liver histology in NAFLD, AHI correlated significantly with lobular inflammation (p < 0.05). In a multivariate analysis, BMI was significantly correlated with lobular inflammation with mean SaO2 nearing significance.

Conclusions

These results indicate that in a homogeneous bariatric population sample with similar characteristics, those with NAFLD had higher AHI and lower minimum SaO2 compared with NL. AHI correlated with liver inflammation suggesting a potential role for intermittent nocturnal hypoxia in the pathogenesis and progression of NAFLD.

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Acknowledgments

The authors are appreciative and acknowledge the important contributions made by the research assistants, clinical staff, surgical staff, bariatric clinic nurses, operating room nurses, and study participants at the University Health Network.

Funding

This study was funded by the Canadian Institutes for Health Research, Operating Grant MOP-126139.

Author information

Authors and Affiliations

  1. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada

    Katherine J. P. Schwenger & Yasaman Ghorbani

  2. Toronto General Hospital, University Health Network, Toronto, Canada

    Katherine J. P. Schwenger, Yasaman Ghorbani, Carrie Li, Sandra E. Fischer & Johane P. Allard

  3. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada

    Sandra E. Fischer

  4. Division of General Surgery, University of Toronto, Toronto, Canada

    Timothy D. Jackson & Allan Okrainec

  5. Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Canada

    Timothy D. Jackson & Allan Okrainec

  6. Department of Medicine, University of Toronto, Toronto, Canada

    Johane P. Allard

  7. Department of Nutritional Sciences, University of Toronto, Toronto, Canada

    Johane P. Allard

  8. Department of Medicine, Division of Gastroenterology, Toronto General Hospital, 585 University Avenue, 9N-973, Toronto, Ontario, M5G 2C4, Canada

    Johane P. Allard

Authors
  1. Katherine J. P. Schwenger
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  2. Yasaman Ghorbani
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  3. Carrie Li
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  4. Sandra E. Fischer
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  5. Timothy D. Jackson
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  6. Allan Okrainec
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  7. Johane P. Allard
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Corresponding author

Correspondence to Johane P. Allard.

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Conflict of Interest

Authors 1–5 and 7 have no conflict of interest to declare. Author 6 has relevant financial activities outside of the submitted work. He is provided an honorarium for speaking and teaching from Ethicon, Medtronic, and Merek.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Schwenger, K.J.P., Ghorbani, Y., Li, C. et al. Obstructive Sleep Apnea and Non-alcoholic Fatty Liver Disease in Obese Patients Undergoing Bariatric Surgery. OBES SURG 30, 2572–2578 (2020). https://doi.org/10.1007/s11695-020-04514-3

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  • DOI: https://doi.org/10.1007/s11695-020-04514-3

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