Hemato-oncologist warns untreated sleep apnea could be putting your liver at risk; suggests signs to look out for and treatment

Sleep apnea may have implications for liver health, particularly when combined with obesity, diabetes or other metabolic risks, according to an oncologist.

Sleep apnea is a potentially serious condition that causes breathing to stop and start several times while you are asleep, according to the Mayo Clinic. While daytime fatigue, poor concentration, mood swings, and long-term health risks like high blood pressure, heart disease, and type 2 diabetes are some of its most common symptoms, it could also impact your liver health.

In an interview with HT Lifestyle, Dr Kasturi Baruah, medical oncologist and hemato-oncologist at M|O|C Cancer Care, Mumbai, elaborated on how a sleep disorder may affect long-term liver health. According to her, loud snoring, disturbed sleep, and constant daytime tiredness are easy to dismiss as part of a hectic routine, but if these symptoms are caused by obstructive sleep apnea (OSA), the problem may not end with a poor night's sleep. Over time, it could also have implications for liver health.

How does OSA occur?

Obstructive sleep apnea (OSA) could also have implications for liver health.

“Repeated occurrences of such phenomena during nighttime may lead to inflammation and cause changes in insulin sensitivity and fat metabolism, which are linked to fatty liver disease,” Dr Kasturi added.

She also cited statistics on the extent of the issues in India to help one understand the problem. “A systematic review and meta-analysis based on eight studies conducted on 11,009 adult participants revealed that 11% had OSA, and 5% were suffering from moderate or severe forms of the disease. Another Indian meta-analysis estimated the prevalence of non-alcoholic fatty liver disease (NAFLD) in adults at 38.6%. Both studies indicate the presence of both diseases,” she stated.

What is the link between fatty liver and sleep apnea?

According to Dr Kasturi, it is well known that the liver controls blood sugar levels, metabolises lipids, and regulates the organism's energy requirements. So, a reduction in oxygen levels in the body due to cessation or restriction of breathing during sleep may disrupt these processes. This may lead to increased insulin resistance, a contributing factor to fat accumulation in the liver, she explained.

“The condition now known as metabolic dysfunction-associated steatotic liver disease (MASLD) occurs when excess fat builds up in the liver alongside metabolic risk factors. It does not progress in the same way for everyone. In some people, however, it can lead to inflammation and fibrosis, or scarring of the liver. In advanced cases, this may progress to cirrhosis,” Dr Kasturi added.

Dr Kasturi also underlined that “sleep apnea should not be viewed merely as a problem of snoring or disturbed sleep. When it coexists with obesity, diabetes, or other metabolic risk factors, it is important to consider the patient's overall health, including liver health. It may form an important part of comprehensive care.”

Sleep apnea treatment also requires the use of a CPAP machine.

Signs and treatment

Though snoring often does not indicate sleep apnea, Dr Kasturi cautioned that certain symptoms should be considered, such as:

⦿ Individuals who snore heavily

⦿ Individuals who suffer from choking sensations while sleeping

⦿ Individuals who experience pauses in breathing noted by someone

⦿ Individuals who have excessive daytime sleepiness

According to the expert, all these individuals should seek the help of a physician. A sleep test may be suggested to diagnose the disease.

In the case of an OSA diagnosis, especially with metabolic risk factors present, Dr Kasturi recommends that a liver status investigation may be necessary. Whether a patient requires an assessment for fatty liver or liver fibrosis depends on his or her medical history and examination findings, she added.

Lastly, she underlined that: “There are several ways of dealing with the disease that may be used according to each person’s specific condition. Weight loss, physical exercise, balanced nutrition, and the regulation of blood glucose and lipid levels may be included in management methods. Sleep apnea treatment may also require the use of CPAP.”

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.