Correlation between Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Disease before and after Metabolic Bariatric Surgery



Emerging evidence has revealed that obstructive sleep apnea (OSA) is associated with non-alcoholic fatty liver disease (NAFLD). However, the impact of OSA on NAFLD among obese patients undergoing metabolic and bariatric surgery (MBS), especially during follow-up period, remains unclear.


To analyze the correlation based on preoperative characteristics and postoperative conditions among bariatric patients with comorbid OSA and NAFLD. Methods: Clinical data of patients who underwent MBS in our institution between January 2016 and June 2019 were reviewed retrospectively. Correlation analysis and linear regressions were used to identify how OSA links with NAFLD before and after treatment of MBS.


Of 308 patients, 181 were diagnosed with OSA and enrolled in the present study, and 127 completed follow-up visits at 6 months. The proportion of NAFLD in the mild-moderate OSA and severe OSA groups was 75.0% and 96.0%, respectively. MBS was effective at improving sleep apnea and nocturnal hypoxia, as well as liver steatosis and fibrosis (P < 0.05). And we also found that there were significant correlations not only between OSA- and NAFLD-related characteristics at baseline but also between their improvements after surgery, eventually leading to similar prognosis of NAFLD for both groups (P < 0.05), no matter what presurgical differences existed. In addition, the results of the univariate and multivariate linear regression analyses supported preoperative liver/spleen Hounsfield units ratio (LSR) by computerized tomography (CT) as an independent predictor of the effect of MBS on liver steatosis.


In conclusion, MBS plays a pivotal role in the control of medical conditions in obese patients with OSA and NAFLD. Given the correlation between OSA and NAFLD in the present study, in the case of both the severity at baseline as well as the improvement after surgery, OSA may pose an impact on the prognosis of NAFLD in bariatric patients.

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This work was supported by the Clinical Research Plan of SHDC (No.16CR2005A) and Clinical Research Program of 9th People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine (JYLJ0130).

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All authors were involved in drafting the article of revising it critically for important intellectual content, and all authors approved the final version to be published. ZYX and YL had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. WB, LXF, YCC, WWY, SJH, SML, YY, DQC, GY, and YJJ were responsible for study conception and design. HM, NJ, SJL, ZL, and SHX were responsible for data acquisition. YWW and YK were responsible for the analysis and interpretation of data.

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Correspondence to X. F. Lu or B. Wang.

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Zhang YX is the first author of this article, and Yang L is the co-first author of this article.

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Zhang, Y.X., Yang, L., Yang, C.C. et al. Correlation between Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Disease before and after Metabolic Bariatric Surgery. OBES SURG (2020).

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  • Obstructive sleep apnea
  • Non-alcoholic fatty liver disease
  • Obesity
  • Metabolic and bariatric surgery
  • Correlation analysis