Insulin Resistance, but Not Obstructive Sleep Apnea Is Associated with Hepatic Steatosis in Chinese Patients with Severe Obesity

Fig. 1.. Flowchart of eligible and available patients in the study.

Fig. 2.. Proportion of patients in different grades of hepatic histopathology and NAS depending on severity of AHI. a Steatosis represented as grade 0, grade 1, grade 2, grade 3. b Lobular inflammation represented as grade 0, grade 1, grade 2, grade 3. c Hepatocyte ballooning represented as grade 0, grade 1, grade 2. d NAS presented as 0–2, 3–4, 5–8. AHI, apnea-hypopnea index; NAS, non-alcoholic fatty liver activity score.

Fig. 3.. Relationship between study sleep variables and BMI, HOMA-IR, and NAFLD-related variables. Heat map showing Spearman correlation between study sleep variables (AHI, ODI, T90%, LaSO2, average SpO2) and BMI, HOMA-IR, ALT, AST, NAS, NASH, steatosis, hepatocyte ballooning, and lobular inflammation. *p < 0.05, **p < 0.01. NAFLD, non-alcoholic fatty liver disease; AHI, apnea-hypopnea index; ODI, oxygen desaturation index; T90%: the percentage of total sleep time spent with SpO2 <90; LaSO2, lowest O2 saturation; average SpO2, average O2 saturation; BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; HOMA-IR, homeostasis model assessment of insulin resistance; NAS, NAFLD activity score; NASH, non-alcoholic steatohepatitis.