Association Between Metabolic Associated Fatty Liver Disease and Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is an increasingly common disorder that is characterized by periodic collapse of the upper airway resulting in cycles of hypoxia and reoxygenation known as chronic intermittent hypoxia(CIH). Evidence has shown that OSA can contribute to the development of many metabolic abnormalities (such as obesity, hyperglycemia, dyslipidemia, and the metabolic syndrome).

Metabolic associated fatty liver disease (MAFLD) has become more common in recent years. MAFLD is thought to be the primary cause of chronic liver disorders, and it has grown to be a significant global public health concern. The prevalence of MAFLD has been steadily rising due to changes in lifestyle and dietary patterns, making it the most common chronic liver ailment globally. The global prevalence of MAFLD is 30.1%.

Evidence emerged that linked OSA severity with the development and progression of MAFLD. For example, CIH (a hallmark of OSA) was identified as an independent risk factor in the onset and progression of MAFLD. The essential links between CIH and MAFLD involve insulin resistance, glucose dysregulation, dysfunction of key steps in hepatic lipid metabolism, oxidative stress, and hepatic steatosis and fibrosis, which together indicate that metabolic dysfunction plays a significant role in the pathogenesis of CIH-associated MAFLD

Inclusion criteria

• Patients aged >18 years old
• presented with a clinical suspicion of sleep-disordered breathing, including snoring, sleepiness and witnessed sleep apnea

Exclusion criteria

• Patients aged ≤18 years old
• Pregnancy
• Presence of malignancy
• Type I DM
• Patients with fatty liver who undergone bariatric surgeries.
• Patients with Central sleep apnea, upper airway resistance and narcolepsy
• Patients with lung diseases with hypoxia
• Previous history of alcohol consumption, steroids, proton pump inhibitors, antibiotics, and contraceptive pills