Liver enzymes in OSA patients at diagnosis: The Mallorca cohort
C. Gruttad'Auria, E. Mazzuca, A. M. Marotta, A. Castrogiovanni, P. Baiamonte, G. Lo Grasso, C. Esquinas, A. Barcelo', F. Barbé, M. R. Bonsignore (Palermo, Italy; Palma de Mallorca, Lleida, Spain)
Source: International Congress 2014 – The story continues: impact of OSA on cardiometabolic parameters
Disease area: Sleep and breathing disorders
Abstract Obstructive sleep apnea (OSA) could be associated with liver injury. The prevalence of increased liver enzymes (ALT/AST>40 IU/L) in OSA patients is undefined. We measured serum ALT and AST in a large series of consecutive patients (n=525) studied by polysomnography in the Sleep Laboratory of the University Hospital, Palma de Mallorca, Spain. Anthropometrics, OSA severity, insulin resistance (HOMA Index, n=320), and Metabolic Index (MetIndex, NCEP-ATP III criteria) were analyzed and correlated with ALT by univariate and stepwise forward multiple regression. Significance was at p<0.05. Increased ALT was found in 96 patients (18.3% of the sample). Increased AST was found in only 23 patients (4.4%). Patients with increased ALT were younger (47.2±10.1 [SD] vs 52.1±13.1 yr, p<0.001), more obese (BMI, 32.9±5.9 vs 30.5±6.3 kg/sqm, p=0.001), sleepier (Epworth 11.2±4.9 vs 9.4±5.1, p=0.002), more insulin resistant (HOMA Index 4.88±3.00 vs 3.53±2.93, p=0.002), and had more severe OSA (AHI 52.0±30.2 vs 41.2±26.3, p=0.0002; lowest SaO2 78.5±9.7 vs 81.3±9.0, p=0.008) than patients with normal ALT values. The MetIndex was higher in patients with increased ALT (2.82±1.25 vs 2.15±1.35, p<0.0001). Weak univariate relationships were found between ALT values and age, neck circumference, waist, waist-to-hip ratio, BMI, AHI, lowest SaO2,HOMA ln, and MetIndex, explaining each 2.5 to 9% of ALT variability. Multiple regression identified age, neck circumference and MetIndex as the only independent variables associated with ALT (R=0.39, p<0.0001, explaining 16% of variability). The data suggest that increased ALT levels in non-morbidly obese OSA patients are associated with markers of visceral obesity rather than OSA severity.
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C. Gruttad'Auria, E. Mazzuca, A. M. Marotta, A. Castrogiovanni, P. Baiamonte, G. Lo Grasso, C. Esquinas, A. Barcelo', F. Barbé, M. R. Bonsignore (Palermo, Italy; Palma de Mallorca, Lleida, Spain). Liver enzymes in OSA patients at diagnosis: The Mallorca cohort. Eur Respir J 2014; 44: Suppl. 58, 1751
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