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. 2026 Feb 10;49(2):zsaf265.
doi: 10.1093/sleep/zsaf265.

Association between obstructive sleep apnea and liver fibrosis in patients with suspected nonalcoholic fatty liver disease

Wojciech Trzepizur  1   2 , Jérôme Boursier  3   4 , Jérémie Poilane  1   2 , Christophe Bureau  5 , Kamila Sedkaoui  6 , Sandrine Pontier  6 , Charlotte Costentin  7   8 , Jean-Louis Pépin  9 , Matthieu Schnee  10 , Acya Bizieux  11 , Maeva Guillaume  12 , Jean-François Hamel  13 , Frédéric Gagnadoux  1   2
Affiliations

Association between obstructive sleep apnea and liver fibrosis in patients with suspected nonalcoholic fatty liver disease

Wojciech Trzepizur et al. Sleep. .

Abstract

Study objectives: The association between obstructive sleep apnea (OSA) and liver fibrosis has been primarily evaluated using noninvasive tools or in selected populations (bariatric surgery). The aim of the study was to determine whether OSA is associated with liver fibrosis in patients with suspected nonalcoholic fatty liver disease (NAFLD) referred for liver biopsy (LB).

Methods: Patients who underwent percutaneous LB for suspected NAFLD were prospectively included and investigated by in-lab polysomnography. Liver lesions were evaluated using the NASH-CRN scoring system and advanced fibrosis was defined as F ≥ 3. Moderate to severe OSA was defined by an apnea-hypopnea index (AHI) ≥15 events/h.

Results: Among the 97 patients included in the study, 40 exhibited advanced fibrosis, while 63 demonstrated moderate to severe OSA. The prevalence of moderate to severe OSA in patients with advanced fibrosis was 82% versus 52% in patients with F0-2 fibrosis stage (p < .0037). The association between moderate to severe OSA and advanced fibrosis remained significant after adjustment for sex, age, diabetes and obesity with an OR of 3.48 (CI = 1.03% to 11.83%; p = .045). Similar association was found with nocturnal hypoxia markers (oxygen desaturation index and the time spent under 90% of saturation). No association was observed between moderate to severe OSA and steatosis or nonalcoholic steatohepatitis.

Conclusions: Utilizing the gold-standard tools for OSA and NAFLD diagnosis in a multicentric cohort of biopsy-proven NAFLD patients, an independent association between OSA and liver fibrosis was confirmed. Statement of Significance This study provides the strongest evidence to date that obstructive sleep apnea (OSA) is independently associated with advanced liver fibrosis in patients with biopsy-proven NAFLD. Unlike prior studies based on indirect measures or bariatric populations, this work used gold-standard diagnostics-full polysomnography and liver histology-in a general NAFLD cohort. The high prevalence of OSA among patients with advanced fibrosis suggests systematic screening may be warranted. These findings identify OSA as a potential modifiable risk factor for liver disease progression.

Keywords: liver fibrosis; nonalcoholic fatty liver disease, NASH; obstructive sleep apnea.

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