https://pubmed.ncbi.nlm.nih.gov/34828697/ NAFLD

Children (Basel). 2021 Nov 1;8(11):984.
doi: 10.3390/children8110984.

Association between Hepatic Steatosis and Obstructive Sleep Apnea in Children and Adolescents with Obesity

Marco Carotenuto 1, Anna Di Sessa 2, Maria Esposito 1, Anna Grandone 2, Pierluigi Marzuillo 2, Ilaria Bitetti 1, Giuseppina Rosaria Umano 2, Francesco Precenzano 1, Emanuele Miraglia Del Giudice 2, Nicola Santoro 3 4

Abstract

Background: Owing to the increasing rate of pediatric obesity, its complications such as non-alcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA) have become prevalent already in childhood. We aimed to assess the relationship between these two diseases in a cohort of children with obesity.

Methods: We enrolled 153 children with obesity (mean age 10.5 ± 2.66, mean BMI 30.9 ± 5.1) showing OSA. Subjects underwent a laboratory evaluation, a cardio-respiratory polysomnography (PSG), and a liver ultrasound.
Results: All subjects had a clinical diagnosis of OSA based on the AHI > 1/h (mean AHI 8.0 ± 5.9; range 2.21-19.0). Of these, 69 showed hepatic steatosis (62.3% as mild, 20.3% as moderate, and 17.4% as severe degree). A strong association between ALT and apnea/hypopnea index (AHI) was observed (p = 0.0003). This association was not confirmed after adjusting for hepatic steatosis (p = 0.53). By subdividing our population according to the presence/absence of steatosis, this association was found only in the steatosis group (p = 0.009). As the severity of steatosis increased, the significance of its association with AHI compared to the absence of steatosis became progressively stronger (all p < 0.0001).

Conclusions: Hepatic steatosis seems to drive the association between OSA and ALT levels, suggesting a potential pathogenic role of OSA in NAFLD.