liver disease

Sleep Apnea Can Worsen Nonalcoholic Fatty Liver Disease


Obesity is a global epidemic. In the U.S. alone, according to the American Heart Foundation, 78 million adults and 13 million children are affected. However, aside from being a disease itself, obesity also poses great risks for developing other serious health complications. Some of the complications are:

  • Metabolic syndrome
  • Heart disease
  • High blood pressure
  • Stroke
  • Type 2 Diabetes
  • Abnormal blood fats (high levels of triglycerides and LDL and low levels of HDL)
  • Increased wear and tear on joints, ligaments and tendons due to excessive weight

While a healthy diet and exercise are the ubiquitous guidelines for achieving and maintaining healthy weight, the solution may be more complicated. Obstructive sleep apnea (OSA) is associated with obesity and weight gain due to oxidative stress, which leads to the development of or exacerbation of obesity, metabolic syndrome and nonalcoholic fatty liver disease (NAFLD) ― a liver manifestation of metabolic syndrome.

Metabolic syndrome is a set of risk factors that increases cardiovascular disease, stroke and diabetes. More than 34 percent of U.S. adults have metabolic syndrome and those affected can become insulin-resistant (preventing the body from using insulin efficiently).

Non-alcoholic fatty liver disease (NAFLD) is the greatest cause of liver disease in the U.S., affecting both adults and adolescents. NAFLD is an excess of fat accumulation in the liver that causes scarring. A recent study from researchers at the University of Colorado School of Medicine showed that obese adolescents suffering from sleep apnea and hypoxia (oxygen deficiency) had greater scar tissue than those without, and are at greater risk of developing a more serious form of liver disease called non-alcoholic steatohepatitis (NASH).

“People suffering from more severe OSA may be more likely to gain more weight than those with less severe OSA over time,” said Dr. Mark Brown, Department of Psychiatry at the University of Arizona College of Medicine in Tucson.

With so many systems and organs affected, achieving and maintaining weight loss through diet, exercise, and/or medication alone is extremely difficult but combined with treatment of OSA, the success could be significantly greater. CPAP is commonly prescribed for the treatment of OSA, but patients do not regularly adhere to wearing the mask so do not receive the maximum benefits of treatment. Oral Appliance Therapy (OAT) is the best alternative to CPAP and patients use the appliance nightly because of its comfort, convenience, and mobility for the patient.

If you struggle with weight loss, are obese, experience symptoms of sleep apnea, or have Type 2 diabetes, speak with your pediatrician or primary care provider to ask for a sleep study or polysomnography (PSG) that monitors breathing, brain waves, oxygen levels in the blood, muscle tension, and eye movements.

Co-authored with Lily Mai.

The information provided is for general knowledge and discussion about medicine, health and related subjects. The words and other con­tent pro­vided in this article and any linked mate­ri­als, are not intended and should not be con­strued as med­ical advice.


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