Increased Oxygen Desaturation Time During Sleep Is a Risk Factor for NASH in Patients With Obstructive Sleep Apnea: A Prospective Cohort Study

Serum sphingomyelin levels define oxyhemoglobin desaturation-related metabolic threshold in symptomatic obstructive sleep apnea

Hypoxia is a contributing factor for the morbidity and mortality in patients with obstructive sleep apnea (OSA). We aimed at identifying the percentage of sleep time with oxyhemoglobin desaturation below 90% (Tc90%) breakpoint from which the most significant changes occur in systemic metabolome of patients with OSA. In a prospective observational study on patients with polysomnography-confirmed symptomatic OSA, profiles of 186 metabolites including amino acids, biogenic amines, acylcarnitines (AC), lysophosphatidylcholines, phosphatidylcholines (PC) and sphingomyelins (SM) were analyzed with liquid chromatography-mass-spectrometry in peripheral blood, obtained at 3 time points that covered patients' night sleep. Comparisons of rank-transformed data with general linear model for repeated measures after dichotomizing the study group at different Tc90% levels were applied to define the best cut-off, hypoxic metabolic threshold (HMT), based on Cohen's f. Fifty-one subjects were recruited with their median Tc90% of 2.1. The mean Cohen's f over the metabolites was highest (0.165) at a Tc90% of 1.8 representing the HMT. Of the different classes of metabolites, the Cohen's f value at HMT was highest for SM (0.322). Compared to patients with Tc90% < HMT, concentrations of 2 PC, 1 AC and 7 SM were significantly higher in patients with Tc90% ≥HMT. The HMT for patients with OSA described in this report for the first time is located at a Tc90% level of 1.8 with SM levels contributing most to the size of this threshold.

Exploring the Impact of Obstructive Sleep Apnea on Cirrhosis: A Comprehensive Review

This paper assesses the existing literature to explore the association between obstructive sleep apnea (OSA) and cirrhosis. While OSA's impact on metabolic dysfunction-associated steatotic liver disease (MASLD) is well-established, limited data exists for other causes of chronic liver disease. The review examines OSA's role in cirrhosis, emphasizing its potential influence on liver disease progression and laying the groundwork for future studies. Current data indicates a greater likelihood of liver disease in individuals with OSA, with continuous positive airway pressure (CPAP) treatment potentially slowing liver disease advancement. Undiagnosed OSA exacerbates liver disease progression, underscoring the urgency of identifying and managing sleep disturbances in patients with liver disease. Patients with a BMI over 30 and liver disease should be screened for sleep disturbances. Addressing sleep issues and OSA could enhance well-being and liver disease management in these patients.

GLP-1 receptor agonists in the treatment of diabetic non-alcoholic steatohepatitis patients

INTRODUCTION

Nonalcoholic fatty liver disease (NAFLD) is the most common hepatic disease affecting almost 30% of the world population. Approximately 25% of people with NAFLD develop nonalcoholic steatohepatitis (NASH), the fulminant version of the disease. Diabetes mellitus is present in 22.5% of people with NAFLD and 44.60% of individuals with NASH. This review was undertaken to examine the current contribution of glucagon-like peptide 1 (GLP-1) receptor agonists to the pharmacotherapy of diabetic nonalcoholic steatohepatitis.

AREAS COVERED

The author analyzed the current status of GLP-1 receptor agonists for pharmacotherapy of diabetic NASH. Research data and literature reports were taken from the database and or websites of Diabetes UK, American Diabetes Association, ClinicalTrials.gov, PubMed, and Scopus. The keywords utilized included type 2 diabetes, GLP-1, NASH, NAFLD, and clinical trials.

EXPERT OPINION

Since diabetic NASH is associated with obesity, diabetes mellitus, oxidative stress and inflammation, drugs capable of mitigating all of these conditions simultaneously, are most ideal for the treatment of diabetic NASH. These drugs include (in order of relevance), GLP-1 receptor agonists, GLP-1 and GIP dual receptor agonists, sodium-glucose co-transporter-2 (SGLT2) inhibitors, and pioglitazone. The future, FDA-approved drug for diabetic NASH treatment will likely be GLP-1 agonist, which could be used as monotherapy or in combination with other drugs.

Sleep apnea-COPD overlap syndrome is associated with larger left carotid atherosclerotic plaques

Background

Little is known about whether the overlap syndrome (OS) combining features of chronic obstructive pulmonary disease (COPD) and sleep apnea-hypopnea syndrome increases the risk of stroke associated with COPD itself.

Methods

We prospectively studied 74 COPD patients and 32 subjects without lung disease. Spirometry and cardiorespiratory polygraphy were used to assess the pulmonary function of the study population and ultrasound measurements of intima media thickness (IMT) as well as the volume of plaques in both carotid arteries were also evaluated.

Results

Polygraphic criteria of OS were met in 51% of COPD patients. We found that 79% of patients with OS and 50% of COPD patients without OS had atherosclerotic plaques in the left carotid artery (p = 0.0509). Interestingly, the mean volume of atherosclerotic plaques was significantly higher in the left carotid artery of COPD patients with OS (0.07 ± 0.02 ml) than in those without OS (0.04 ± 0.02 ml, p = 0.0305). However, regardless of the presence of OS, no significant differences were observed in both presence and volume of atherosclerotic plaques in the right carotid artery of COPD patients. Adjusted-multivariate linear regression revealed age, current smoking and the apnea/hypopnea index (OR = 4.54, p = 0.012) as independent predictors of left carotid atherosclerotic plaques in COPD patients.

Conclusions

This study suggests that the presence of OS in COPD patients is associated with larger left carotid atherosclerotic plaques, indicating that OS might be screened in all COPD patients to identify those with higher risk of stroke.