Obstructive sleep apnea syndrome and fatty liver: Association or causal link?

Figure 1 Obstructive sleep apnea can induce non-alcoholic fatty liver disease through increasing insulin resistance, dyslipidemia and inflammation. The presence of metabolic syndrome and obesity with obstructive sleep apnea (OSA) can aggravate non-alcoholic fatty liver disease (NAFLD). OSA might aggravate NAFLD in the absence of obesity and metabolic syndrome.

Figure 2 The complex relationship between non-alcoholic fatty liver disease, obstructive sleep apnea and insulin resistance. TNF: Tumor necrosis factor; NAFLD: Non-alcoholic fatty liver disease; PPAR: Peroxisome-proliferator-activated receptor; SREBP-1c: Sterol-regulatory-element-binding protein-1c.

Figure 3 Association of non-alcoholic fatty liver disease and obstructive sleep apnea with cardiovascular disease. Whether the combination of non-alcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA) has a synergistic effect in the incidence of cardiovascular disease (CVD) needs to be demonstrated.