Impact of continuous positive airway pressure on liver injury induced by obstructive sleep apnea: Data from randomized controlled trials

Abstract

Rationale: Obstructive sleep apnea (OSA) is an independent risk factor for nonalcoholic fatty liver disease (NAFLD) occurrence and progression. The impact of continuous positive airway pressure (CPAP) on non invasive markers of NAFLD has never been studied. Methods: Values of Fibromax® test (SteatoTest®, NashTest® and FibroTest®) were measured from randomized sham controlled studies before and after 6 to 12 weeks of sham (control) versus effective CPAP in 103 severe OSA patients (AHI > 30/h). ClinicalTrials n°: [NCT01196845][1] / [NCT00464659][2] / [NCT00669695][3]. Results: Key demographics of the study population were: age 57 (49 / 62) (median, 25th / 75th percentiles) years, 21% female, BMI 28.2 (26.0 / 32.0) median, 25th / 75th percentiles) kg/m2. At baseline, 40.4% of patients in the sham CPAP group and 45.5% in the CPAP group exhibited liver steatosis. Furthermore, 39.6% of patients in the sham CPAP group and 58.4% in the CPAP group displayed borderline or possible nonalcoholic steatohepatitis (NASH). Effective CPAP had no impact on steatosis, NASH and fibrosis even after adjustment for gender, BMI, baseline AHI and severity of liver injury. Conclusion: A number of non invasive markers of liver injury are increased in untreated OSA patients, potentially contributing to cardiometabolic risk, but they did not fall with 6 to 12 weeks of CPAP treatment. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01196845&atom=%2Ferj%2F46%2Fsuppl_59%2FOA299.atom [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00464659&atom=%2Ferj%2F46%2Fsuppl_59%2FOA299.atom [3]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00669695&atom=%2Ferj%2F46%2Fsuppl_59%2FOA299.atom