Obstructive sleep apnea (OSA) has been suggested to be a potential contributing factor for nonalcoholic steatohepatitis (NASH). The oxidative stress caused by chronic intermittent hypoxia is known to play a vital role in the pathogenesis of NASH. There is conflicting data in the literature regarding the association of OSA and NASH. The primary purpose of this study was to determine the association of OSA and NASH from a large national inpatient sample database.
We conducted a retrospective analysis using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). NASH patients were identified by ICD-10-CM code K75.81. Non-NASH patients (control) were randomly selected and matched to each NASH patient 4:1 by age and gender. Weighted logistic regression models were used to calculate the association between OSA and NASH for different comorbidities.
A total of 54,169 patients were included in our analysis, 10,740 cases of NASH were matched to 43,429 controls (non-NASH). NASH was significantly higher in the white population (82.12% vs. 76.64%, P < 0.001). The prevalence of NASH among OSA patients was significantly higher compared to the non-OSA group (15.8% vs. 8.9%; adjusted OR: 1.34, 95% CI: 1.14–1.56, P = 0.0003). Celiac disease and Crohn’s disease were significantly higher in patients with NASH (0.7% vs. 0.2%, P < 0.0002 and 1.28% vs. 0.76%, P < 0.0001). Multiple comorbidities were significantly elevated in the NASH group compared to the non-NASH group including diabetes mellitus (36.0% vs. 17.6%, P < 0.0001), obesity (36.4% vs. 18.2%, P < 0.0001) and metabolic syndrome (0.86% vs. 0.06%, P < 0.0001). Mortality rate was significantly higher in the NASH group (3.8% vs. 2.0%, P < 0.0001).
This is the first study using ICD-10-CM code with a specific search code for NASH. Our large population database results emphasize that there is a significant association between OSA and NASH. This important association should prompt physicians to evaluate for the presence of NASH in OSA patients. Additional studies are needed to evaluate this association and the effect of OSA treatment on NASH.