Management of non-alcoholic fatty liver disease patients with sleep apnea syndrome

Table 1 Effects of current strategies on nonalcoholic fatty liver disease with sleep apnea syndrome

Category		Effects	Ref.
Lifestyle measures	Mediterranean diet	Inhibition of inflammation and oxidative stress that occur in OSAHS and improvement of upper-airway neuromuscular control and muscle force-generating capacity	[51]
	Dietary behavior change, moderate-intensity aerobic exercise, sleep hygiene, and tobacco and alcohol avoidance	Increases in adherence to the Mediterranean diet	[52]
		Reduced AHI and oxygen desaturation index
		Increased sleep quality
		Decease of body weight, fat mass, visceral adipose tissue, and neck, chest, and waist circumferences
	Aerobic exercise training	Reduced body weight improved blood circulation, better sleep quality and less daytime sleepiness	[56-58]
Medications	Phentermine plus extended-release topiramate	Significant improvements in overnight oxygen saturation and reduction in blood pressure	[42]
	Liraglutide and semaglutide	Histological resolution of NASH and improved metabolic control	[43-48]
		Decreased AHI, body weight, SBP and HbA1c
MBS	VSG or other MBS	Reduced AHI	[62-64]
	VSG	100% remission rate in patients with OSAHS who also underwent hiatal hernia repair	[65]
	MBS	Improved sleep apnea and nocturnal hypoxia, as well as liver steatosis and fibrosis	[66]

OSAHS: Obstructive sleep apnea hypopnea syndrome; AHI: Apnea hypoventilation index; NASH: Nonalcoholic steatohepatitis; SBP: Systolic blood pressure; HbA1c: Glycated hemoglobin; MBS: Metabolic bariatric surgery; VSG: Vertical sleeve gastrectomy.