What Is Obstructive Sleep Apnea and How Is It Connected to Liver Health?

What is Sleep Apnea?

Sleep apnea is a condition that causes an individual to repeatedly stop breathing during sleep. This results into poor sleep quality and lower oxygen levels in the blood. If remained untreated, sleep apnea can lead to serious health complications.

There are several types of sleep apnea with obstructive sleep apnea (OSA) being the most common one. Obstructive sleep apnea is characterized by blocking of the upper airway during sleep which compromises the airflow.

Obstructive sleep apnea is up to 40% prevalent in patients suffering from metabolic syndrome, non-alcoholic fatty liver disease, diabetes, obesity, kidney and heart disease, according to studies.

Symptoms of Sleep Apnea

According to the National Heart, Lung, and Blood Institute, the most common symptoms of sleep apnea are snoring or gasping during sleep, reduced or absent breathing, and sleepiness.

Risk Factors of Sleep Apnea

According to Mayo Clinic, the risk factors of sleep apnea can include:

• Being overweight or obese
• Being male and middle-aged
• High blood pressure
• Family history of sleep apnea or snoring
• Congested nose
• Alcohol consumption
• Diabetes
• Asthma
• Large neck size
• Smoking

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How is Sleep Apnea Linked to Liver Disease?

Recent studies have shown that obstructive sleep apnea (OSA) can be a risk factor of non-alcoholic fatty liver disease (NAFLD) which means it is directly associated with the development and progression of liver disease. This connection between NAFLD and obstructive sleep apnea remains even in the absence of OSA major risk factors such as obesity and metabolic syndrome.

Obstructive sleep apnea causes chronic intermittent hypoxia which negatively impacts the liver leading to disrupted lipid metabolism, inflammation, insulin resistance, liver steatosis, and atherosclerosis. These factors are crucial in the development and progression of non-alcoholic fatty liver disease.

Also, the severity of OSA is directly linked to the severity of non-alcoholic fatty liver disease. This is why, if you are diagnosed with non-alcoholic fatty liver disease, it is recommended to be regularly screened for obstructive sleep apnea and vice versa.

According to studies, treating OSA may not improve non-alcoholic fatty liver disease directly, but it may stop or slow down the disease progression.

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Sources:

Obstructive Sleep Apnea, Hypoxia, and Nonalcoholic Fatty Liver Disease. Mesarwi OA, Loomba R, Malhotra A. Am J Respir Crit Care Med. 2019 Apr 1;199(7):830-841. doi: 10.1164/rccm.201806-1109TR. PMID: 30422676.

Aron-Wisnewsky J, Clement K, Pépin JL. Nonalcoholic fatty liver disease and obstructive sleep apnea. Metabolism. 2016 Aug;65(8):1124-35. doi: 10.1016/j.metabol.2016.05.004. Epub 2016 May 13. PMID: 27324067.

Mayo Clinic