Pathophysiological Mechanisms Linking Obstructive Sleep Apnea to Nonalcoholic Fatty Liver Disease

• Published in: Sleep medicine research Vol. 16; no. 2; pp. 93 - 102
• Main Authors: Dongol, Eptehal Mohammed, Hamdan, Fatma Rabea Ahmed, Ahmed, Omyma Galal, Abdel-Aziz, Rehab Hemdan, Younes, Mahitab, Ahmed, Rana Toghan
• Format: Journal Article
• Language: English
• Published: Korean Society of Sleep Medicine 01.06.2025; 대한수면학회
• Subjects: hypoxia; metabolic syndrome; non-alcoholic fatty liver disease; obstructive sleep apnea; sleep fragmentation; 정신과학
• ISSN: 2093-9175; 2233-8853
• DOI: 10.17241/smr.2025.02859

Sleep plays a crucial biological role and is responsible for overall well-being. Poor sleep is associated with several negative health conditions. Sleep fragmentation and chronic intermittent hypoxia in patients with obstructive sleep apnea can lead to several negative health effects, including a collection of metabolic disorders known as “metabolic syndrome,” which includes the development of non-alcoholic fatty liver disease. Decreased O2 at the tissue level leads to the development of adaptive mechanisms, including hypoxia-induced signalling as hypoxia-inducible factors, stress responses as endoplasmic reticulum stress, and autophagy by reactive oxygen species. In addition to this, disrupted gut barrier integrity, increased gut permeability, dyslipidemia, and insulin resistance have a pathologic role in non-alcoholic fatty liver disease development. The prognosis of non-alcoholic fatty liver disease in obstructive sleep apnea is a multifactorial process. Our review will clarify the complex and multifactorial pathophysiological mechanisms that contribute to the development of non-alcoholic fatty liver disease in patients with obstructive sleep apnea, as well as how the condition may progress to non-alcoholic steatohepatitis.