Non-alcoholic fatty liver disease as metabolic consequence of obstructive sleep apnea

  • Ana Ninić University of Belgrade - Faculty of Pharmacy, Department of Medical Biochemistry
  • Marija Zdravković University of Belgrade - Faculty of Medicine, University Medical Center “Bežanijska kosa”, Department of Cardiology
  • Vojislav Radosavljević Department of Pulmology, University Medical Center “Bežanijska kosa”
  • Vera Gardijan Department of Pulmology, University Medical Center “Bežanijska kosa”
  • Lidija Memon Department of Laboratory Diagnostics, University Medical Center “Bežanijska kosa”
  • Jelena Vekić University of Belgrade – Faculty of Pharmacy, Department for Medical Biochemistry
  • Vesna Spasojević-Kalimanovska University of Belgrade – Faculty of Pharmacy, Department for Medical Biochemistry
Keywords: obstructive sleep apnea, chronic intermittent hypoxia, non-alcoholic fatty liver disease, fibrosis


Obstructive sleep apnea (OSA) as a worldwide prevalent condition carries risk for cardiovascular and metabolic diseases, ultimately increasing overall mortality rates. Non-alcoholic fatty liver disease (NAFLD) can be considered as the primary metabolic disease, but also as a coexisting OSA comorbidity. Although prevalence of NAFLD covers quarter of world population, it increases with OSA presence. It can be speculated that chronic intermittent hypoxia (CIH) and sympathetic nervous system overactivity are involved in NAFLD pathogenesis and progression from simple steatosis through steatohepatitis to fibrosis. CIH provides the environment for liver oxidative stress, inflammation and increases the expression of genes involved in cholesterol and fatty acids synthesis. Catecholamines increase β-oxidation in liver and release free fatty acids from adipose tissue in plasma which inhibit insulin effects. Obesity and insulin resistance as key players in NAFLD development and advancement, deepen vicious circle of oxidative stress, inflammation and dyslipidemia. If not treated, OSA in NAFLD patients has been associated with inflammation, hepatocytes’ necrosis, and fibrosis. Continuous positive airway pressure (CPAP) represents gold standard for OSA therapy, allowing the unimpeded air passage through upper parts of respiratory system. However, it has been demonstrated that CPAP therapy have beneficial effects on cardiometabolic outcomes and slow liver degeneration.


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