Seda Beyhan SAĞMEN, Elif TORUN PARMAKSIZ, Sevda ŞENER CÖMERT, Ali FİDAN, Banu SALEPÇİ

Liver functions in patients with obstructive sleep apnea syndrome

Objective: Previous studies showed that obstructive sleep apnea syndrome (OSAS) was associated with liver diseases such as elevated liver enzyme levels and hepatic steatosis. The aim of this study was to assess the relationship between serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels and OSAS and its severity. Methods: A total of 617 patients who underwent PSG (polysomnography) between January 2016 and May 2017 were evaluated in this study. AST, ALT, total cholesterol, triglyceride levels and body mass index were analyzed. The data were analyzed using the Student t-test, ANOVA, Chi-square test, and Pearson's correlation coefficient. Results: Five hundreds and thirty patients with OSAS and 60 healthy controls were included in the study. Of the patients in the OSAS group, 17.7% had an elevated ALT level and 7.9% had an elevated AST level. There was a statistically significant difference in ALT and AST levels between the OSAS and control groups (p < 0.001 and p < 0.001, respectively). In the OSAS group, there was a statistically significant positive relationship between serum ALT and AST levels and apnea-hypopnea index (AHI), apnea index, oxygen desaturation index. Both AST and ALT levels were statistically significantly higher in obese patients than in non-obese patients (p < 0.001 and p < 0.001, respectively). ALT level was statistically significantly higher in patients without hypertension than in patients with hypertension (p < 0.001). In OSAS patients without hypertension, there was a statistically significant relationship between serum ALT and AST levels and AHI (r = 0.223, p < 0.001 and r = 0.142, p = 0.007; respectively). Conclusion: OSAS is a risk factor for elevated liver enzyme levels. Hypoxia plays an important role on liver enzymes in OSAS patients.

Keywords:

liver enzymes, obstructive sleep apnea syndrome, hypertension,

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[1] Lindberg E, Gislason T. Epidemiology of sleep-related obstructive breathing. Sleep Med Rev 2000;4:411-33.
[2] Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008;5:136-43.
[3] Lam JC, Lam B, Lam CL, Fong D, Wang JK, Tse HF, et al. Obstructive sleep apnea and the metabolic syndrome in community-based Chinese adults in Hong Kong. Respir Med 2006;100:980-7.
[4] Somers VK, Dyken ME, Clary MP, Abbod FM Symphathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995;96:1897-904.
[5] Oh SY, Cho YK, Kang MS, Yoo TW, Park JH, Kim HJ, et al. The association between increased alanine aminotransferase activity and metabolic factors in nonalcoholic fatty liver disease. Metab Clin Exp 2006;55:1604-9.
[6] Tanne, F, Gagnadoux, F, Chazouilleres O, Fleury B, Wendum D, Lasnier E, et al. Chronic liver injury during obstructive sleep apnea. Hepatology 2005;41:1290-6.
[7] Savransky V, Bevans S, Nanayakkara A, Li J, Smith PL, Torbenson MS, et al. Chronic intermittent hypoxia causes hepatitis in a mouse model of diet-induced fatty liver. Am J Physiol Gastrointest Liver Physiol 2007;293:G871-7.
[8] Byrne TJ, Parish JM, Somers V, Aqel BA, Rakela J. Evidence for liver injury in the setting of obstructive sleep apnea. Ann Hepatol 2012;11:228-31.
[9] Jouët P, Sabaté JM, Maillard D, Msika S, Mechler C, Ledoux S, et al. Relationship between obstructive sleep apnea and liver abnormalities in morbidly obese patients: A prospective study. Obes Surg 2007;17:478-85.
[10] Sookoian S, Pirola CJ. Obstructive sleep apnea is associated with fatty liver and abnormal liver enzymes: A meta-analysis. Obes Surg 2013;23:1815-25.
[11] Li J, Zhang YL, Chen R, Wang Y, Xiong KP, Huang JY, et al. Elevated serum liver enzymes in patients with obstructive sleep apnea-hypopnea syndrome. Chin Med J (Engl) 2015;128: 2983-7.
[12] Chin K, Nakamura T, Takahashi K, Sumi K, Ogawa Y, Masuzaki H, et al. Effects of obstructive sleep apnea syndrome on serum aminotransferase levels in obese patients. Am J Med 2003;114:370-6.
[13] Norman N, Bardwell WA, Arosemena F, Nelesen R, Mills PJ, Loredo JS, et al. Serum aminotransferase levels are associated with markers of hypoxia in patients with obstructive sleep apnea. Sleep 2008;31:121-6.
[14] Daltro C, Cotrim HP, Alves E, de Freitas LA, Araújo L, Boente L, et al. Nonalcoholic fatty liver disease associated with obstructive sleep apnea: Just a coincidence? Obes Surg 2010;20:1536-43.
[15] Mishra P, Nugent C, Afendy A, Bai C, Bhatia P, Afendy M, et al. Apnoeic-hypopnoeic episodes during obstructive sleep apnoea are associated with histological nonalcoholic steatohepatitis. Liver Int 2008;28:1080-6.
[16] Sadasivam K, Patial K, Ravi K, Aiyyavo S. Liver enzymes in obstructive sleep apnoea syndrome. Natl J of Physiol, Pharm Pharmacol 2017;7:865-9.
[17] Sookoian S, Rosselli MS, Gemma C, Burgueño AL, Fernández Gianotti T, Castaño GO, et al. Epigenetic regulation of insulin resistance in nonalcoholic fatty liver disease: impact of liver methylation of the peroxisome proliferator-activated receptor γ coactivator 1α promoter. Hepatology 2010;52:1992-2000.
[18] Rosmorduc O, Housset C. Hypoxia: a link between fibrogenesis, angiogenesis, and carcinogenesis in liver disease. Semin Liver Dis 2010;30:258-70.