OSA SEVERITY IS ASSOCIATED WITH INCREASED STEATOSIS AND LIVER STIFFNESS IN PATIENTS WITH HEPATIC PATHOLOGY INDEPENDENT OF BMI

Abstract

SESSION TITLE: Advances Across the Diagnostic Spectrum in Sleep-Disordered Breathing SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: The diagnosis of obstructive sleep apnea (OSA) and severity of OSA by apnea-hypopnea index (AHI), has been associated with an increased risk of developing liver disease in population-based studies, and the severity of nocturnal hypoxia has been associated with worsening steatosis biomarkers. Further, nocturnal hypoxia has been associated with increased biopsy-proven fibrosis in patients undergoing bariatric surgery. FibroScan/Transient Elastography (EchoSens,Paris,France) is a non-invasive technique that uses ultrasound to measure liver stiffness and assess fibrosis with high reproducibility. The controlled attenuation parameter (CAP) has demonstrated good accuracy in quantifying the levels of liver steatosis and fibrosis, which are associated with the progression of hepatic disease, although with some variability by age, body mass index (BMI), and geography by meta-analysis. The goal of this retrospective study was to assess the relationship between OSA severity, body mass index, and liver stiffness measurements (LSM) by transient elastography with CAP (controlled attenuation parameter) in liver cirrhosis and steatosis. METHODS: Patients who had both a polysomnogram (PSG) and liver elastography between March 2015 - March 2020 were identified by Epic EMR SlicerDicer tool. Patients were included if they had a diagnostic or split-night PSG, and elastography occurred within 12 months prior and 3 months after PSG. AHI was calculated by American Academy of Sleep Medicine recommended criteria. Elastography readings with an interquartile range (IQR) greater than 30% of the mean were excluded as unreliable per literature cutoffs. Sleep and liver diagnoses were identified from the associated attending reports. Multiple linear models with AHI, BMI and etiology of liver disease were created. Analysis was performed using Microsoft Excel. RESULTS: Twenty-three subjects were identified. AHI (p=0.002) and BMI (p<0.001) are independently associated with increased liver attenuation. AHI (p=0.008) is associated with increased liver stiffness in non-obese patients with hepatitis C (n=14). For non-alcoholic steatohepatitis patients, BMI is associated with increased stiffness (p=0.03), but not increased attenuation. CONCLUSIONS: OSA severity is associated with worsening liver steatosis on elastography in patients with cirrhosis and steatohepatitis. In non-obese patients with hepatitis C, OSA severity is associated with worsening fibrosis on elastography. CLINICAL IMPLICATIONS: Patients with cirrhosis and hepatic steatosis should be screened for OSA, regardless of BMI or etiology of liver disease. Treatment of OSA may slow progression of liver disease. Liver attenuation should be interpreted with caution in patients with obesity and nonalcoholic steatohepatitis, as it may not accurately reflect severity of liver disease. DISCLOSURES: No relevant relationships by Bredon Crawford, source=Web Response No relevant relationships by Vidya Krishnan, source=Web Response No relevant relationships by Nicoleta Olteanu, source=Web Response