Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun;24(2):94-101.
doi: 10.5114/pm.2025.152991. Epub 2025 Jul 28.

Effect of lifestyle changes on liver enzymes, triglycerides, sex hormones, and daytime sleepiness in polycystic ovarian syndrome women with obstructive sleep apnea and fatty liver - a randomized controlled trial

Ali Mohamed Ali Ismail  1 , Nehad Mohamed AbdElnabi Mousa  2 , Sami Kamal Mohamed Elgendy  3 , Asmaa M Al-Emrany  4 , Orchid Saber AbdelFadil Saber  5 , Sahar Mohamed Adel Elhakk  6   7 , Dina Mohamed  8   9 , Heba Ahmed Mousa Ghaleb  1   10
Affiliations

Effect of lifestyle changes on liver enzymes, triglycerides, sex hormones, and daytime sleepiness in polycystic ovarian syndrome women with obstructive sleep apnea and fatty liver - a randomized controlled trial

Ali Mohamed Ali Ismail et al. Prz Menopauzalny. 2025 Jun.

Abstract

Introduction: Lifestyle changes are one of the main therapeutic approaches for women with polycystic ovarian syndrome (PCOS), non-alcoholic fatty liver disease (NAFLD), and obstructive sleep apnea (OSA). This 8-week study aimed to assess the effect of lifestyle modifications on liver enzymes, triglycerides (TG), sex hormones, and daytime sleepiness in PCOS women with NAFLD and mild and moderate OSA.

Material and methods: This study included 40 women. The included obese PCOS women with OSA and NAFLD were assigned randomly to the study group and control group (n = 20 for each PCOS group). Besides the low-calorie diet (LCD), both PCOS groups received 500 mg of metformin tablets consumed three times daily. The study group additionally received free 30-minute walking exercise daily. Besides aspartate transaminase, alanine transaminase, and TG, the following outcomes were assessed in all PCOS women with OSA and NAFLD: waist circumference, neck circumference, body mass index, waist-hip ratio, serum testosterone, ratio of luteinizing hormone and follicle-stimulating hormone, apnea-hypopnea index, dehydroepiandrosterone, and Epworth sleepiness scale (to assess excessive daytime sleepiness).

Results: A significant improvement in the value of all outcomes was achieved in both PCOS groups, but the improvements were high in the study group. Also, the designed between-group comparison of post values of PCOS women's outcomes showed a significant improvement in the study group.

Conclusions: Adding eight weeks of free-walking exercise to LCD and administration of metformin resulted in significantly greater improvements in PCOS than LCD and administration of metformin alone in women with NAFLD and OSA.

Keywords: diet; non-alcoholic fatty liver; obstructive sleep apnea; polycystic ovarian syndrome; weight loss.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Flow chart of polycystic ovarian syndrome women with obstructive sleep apnea and nonalcoholic fatty liver disease NAFLD – nonalcoholic fatty liver disease, OSA – obstructive sleep apnea, PCOS – polycystic ovarian syndrome
See this image and copyright information in PMC

References

    1. Ismail AMA. Virtual reality-based exercise in adolescents with polycystic ovarian syndrome-induced fatty liver: an interesting and entertaining method requiring more attention. Curr Womens Health Rev 2024. Available from: 10.2174/0115734048339094241106052337. - DOI
    1. Ismail AMA, Saad AE, Draz RS. Effect of low-calorie diet on psoriasis severity index, triglycerides, liver enzymes, and quality of life in psoriatic patients with non-alcoholic fatty liver disease. Reumatologia 2023; 61: 116-122. - PMC - PubMed
    1. Doycheva I, Ehrmann DA. Nonalcoholic fatty liver disease and obstructive sleep apnea in women with polycystic ovary syndrome. Fertil Steril 2022; 117: 897-911. - PubMed
    1. Tock L, Carneiro G, Togeiro SM, et al. Obstructive sleep apnea predisposes to nonalcoholic Fatty liver disease in patients with polycystic ovary syndrome. Endocr Pract 2014; 20: 244-251. - PubMed
    1. Kite C, Lahart IM, Afzal I, et al. Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Syst Rev 2019; 8: 51. - PMC - PubMed

LinkOut - more resources