Association of Obstructive Sleep Apnea with Nonalcoholic Fatty Liver Disease: Evidence, Mechanism, and Treatment

Nat Sci Sleep. 2024 Jul 8:16:917-933. doi: 10.2147/NSS.S468420. eCollection 2024.

Abstract

Obstructive sleep apnea (OSA), a common sleep-disordered breathing condition, is characterized by intermittent hypoxia (IH) and sleep fragmentation and has been implicated in the pathogenesis and severity of nonalcoholic fatty liver disease (NAFLD). Abnormal molecular changes mediated by IH, such as high expression of hypoxia-inducible factors, are reportedly involved in abnormal pathophysiological states, including insulin resistance, abnormal lipid metabolism, cell death, and inflammation, which mediate the development of NAFLD. However, the relationship between IH and NAFLD remains to be fully elucidated. In this review, we discuss the clinical correlation between OSA and NAFLD, focusing on the molecular mechanisms of IH in NAFLD progression. We meticulously summarize clinical studies evaluating the therapeutic efficacy of continuous positive airway pressure treatment for NAFLD in OSA. Additionally, we compile potential molecular biomarkers for the co-occurrence of OSA and NAFLD. Finally, we discuss the current research progress and challenges in the field of OSA and NAFLD and propose future directions and prospects.

Keywords: dyslipidemia; hypoxia-inducible factor 1 alpha; intermittent hypoxia; leptin resistance; nonalcoholic fatty liver disease; oxidative stress.

Publication types

  • Review

Grants and funding

This work was supported by the Hubei Provincial Natural Science Foundation of China (No. 2024AFB050), the National Key Research and Development Program (No. 2021YFC2500702), the National Natural Science Foundation of China (Nos. 82270104 and 82201268), the Scientific Research Project of the Hubei Provincial Commission of Health (No. WJ2023Z010), the Young Doctors’ Innovation and Development Program (No. HXQNJJ-2023-010), the Moderate and Severe Asthma Diagnosis and Treatment Scientific Research Project (No. Z001), and the Fundamental Research Funds for the Central Universities (No. 2042023kf0044).