Non-alcoholic fatty liver disease fibrosis score is a useful tool for carotid atherosclerosis screening in patients with obstructive sleep apnea

Figure 1 Flowchart with the case selection of patients included in the study. 221 patients were enrolled because of snoring and/or obstructive sleep apnea suspicion. 74 patients were discarded due to chronic obstructive pulmonary disease and 3 due to missing relevant data. After performing night polysomnography, 112 patients were diagnosed as obstructive sleep apnea and 32 were enrolled as matched control subjects. OSA: Obstructive sleep apnea; COPD: Chronic obstructive pulmonary disease.

Figure 2 Vascular characteristics of the study cohort according to obstructive sleep apnea presence. All values in control (n = 32) and obstructive sleep apnea (n = 112) groups are expressed as mean ± SD. A: Vascular reactivity expressed in percentage of brachial artery dilatation after ischemia; B: Intima-media thickness expressed as mean of left and right carotid arteries; C: Presence of carotid atheromatous plaques; D: Carotid plaque volume expressed as mean of left and right carotid plaques. OSA: Obstructive sleep apnea.

Figure 3 Diagnostic accuracy of non-alcoholic fatty liver disease fibrosis score to predict carotid atherosclerosis in patients with obstructive sleep apnea. A: Receiver operating characteristic curve for non-alcoholic fatty liver disease fibrosis score and fibrosis-4 to predict carotid atherosclerosis in patients with obstructive sleep apnea (n = 112); B: Receiver operating characteristic curve for the non-alcoholic fatty liver disease fibrosis score model along with arterial hypertension and current smoking status to predict carotid atherosclerosis in patients with obstructive sleep apnea (n = 112). NFS: Non-alcoholic fatty liver disease fibrosis score; FIB-4: Fibrosis-4; AUROC: Area under the receiver operating characteristic curve.

Figure 4 Non-alcoholic fatty liver disease fibrosis score is related to carotid plaque presence and volume in patients with obstructive sleep apnea regardless of metabolic dysfunction-associated steatotic liver disease presence. All values are expressed as mean ± SD. A and B: Non-alcoholic fatty liver disease fibrosis score and fibrosis-4 scores in obstructive sleep apnea patients without metabolic dysfunction-associated steatotic liver disease according to carotid plaque absence (n = 6) or presence (n = 10); C and D: Spearman correlations for non-alcoholic fatty liver disease fibrosis score and fibrosis-4 scores and carotid plaque volume in obstructive sleep apnea patients without metabolic dysfunction-associated steatotic liver disease and carotid plaque presence (n = 10). NFS: Non-alcoholic fatty liver disease fibrosis score; FIB-4: Fibrosis-4.