Continuous Positive Airway Pressure Does Not Improve Nonalcoholic Fatty Liver Disease in Patients with Obstructive Sleep Apnea. A Randomized Clinical Trial

Obstructive sleep apnea (OSA) is associated with development of nonalcoholic fatty liver disease (NAFLD). The effects of continuous positive airway pressure (CPAP) on NAFLD in patients with concomitant OSA are unknown. To investigate the effects of autoadjusting CPAP versus subtherapeutic CPAP treat...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2021-02, Vol.203 (4), p.493-501
Main Authors: Ng, Susanna S S, Wong, Vincent W S, Wong, Grace L H, Chu, Winnie C W, Chan, Tat-On, To, Kin-Wang, Ko, Fanny W S, Chan, Ka-Pang, Hui, David S
Format: Article
Language:English
Subjects:
Adult
Aged
Airway management
Comorbidity
Continuous positive airway pressure
Continuous Positive Airway Pressure - methods
Female
Humans
Intermittent Positive-Pressure Ventilation - methods
Liver diseases
Male
Middle Aged
Non-alcoholic Fatty Liver Disease - etiology
Non-alcoholic Fatty Liver Disease - therapy
Pulmonary fibrosis
Sleep apnea
Sleep Apnea, Obstructive - complications
Sleep Apnea, Obstructive - therapy
Treatment Outcome
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Summary:Obstructive sleep apnea (OSA) is associated with development of nonalcoholic fatty liver disease (NAFLD). The effects of continuous positive airway pressure (CPAP) on NAFLD in patients with concomitant OSA are unknown. To investigate the effects of autoadjusting CPAP versus subtherapeutic CPAP treatment over 6 months on NAFLD activities. Patients with NAFLD and OSA, as defined by respiratory event index ≥5/h diagnosed by a validated level 3 Embletta device, were randomized into group A) autoadjusting CPAP (4-20 cm H O) or group B) subtherapeutic CPAP (pressure fixed at 4 cm H O). The primary endpoint was the difference in changes in intrahepatic triglyceride as measured by proton magnetic resonance spectroscopy after 6 months of therapy. Key secondary endpoints included changes in controlled attenuation parameter (CAP) and liver stiffness measurement measured with transient elastography, and serum cytokeratin-18 fragment. A total of 120 patients were randomized equally into two groups. There were significant correlations between CAP and respiratory event index (  = 0.203,  = 0.026), percentage of total recording time with Sa  
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.202005-1868OC