ArticleJournal of hepatology2016
Nocturnal hypoxia-induced oxidative stress promotes progression of pediatric non-alcoholic fatty liver disease.
Article in Journal of hepatology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 1 of them a synthesis that pooled it.
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Who cites it
42 citing papers in PubMed, 1 synthesis or guideline pooled it, 75 citations in OpenAlex.
- Association between obstructive sleep apnea and non-alcoholic fatty liver disease: a systematic review and meta-analysis.Sleep & breathing = Schlaf & Atmung · 2018Pooled it
- Outcome of Targeted Therapy for Obstructive Sleep Apnea in Children with Obesity and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).Children (Basel, Switzerland) · 2026Article
- Metabolic Dysfunction-Associated Steatotic Liver Disease in Childhood: From Disease Heterogeneity to Personalized Care.Journal of personalized medicine · 2026Review
- Mechanistic insights and evidence-based management of metabolic dysfunction-associated steatotic liver disease (MASLD; formerly NAFLD) through combined diet and exercise interventions: an evidence-based narrative review.Journal of clinical biochemistry and nutrition · 2026Review
- Comparative effects of exercise modalities on ectopic fat reduction in overweight and obese children and adolescents: a narrative review.European journal of pediatrics · 2026Review
- The triadic relationship between obesity, obstructive sleep apnea and metabolic dysfunction-associated steatotic liver disease in children: a scoping review.Sleep & breathing = Schlaf & Atmung · 2026Article
- Hypoxia-inducible factors in the immunometabolism of metabolic dysfunction-associated steatotic liver disease (MASLD): molecular mechanisms and therapeutic implications.Frontiers in physiology · 2026Article
- Gut Microbiota Regulate Lipid Metabolism via the Bile Acid Pathway: Resistance to Hypoxia in Gansu Zokor (Eospalax cansus).Integrative zoology · 2025Article
- Article
- A new investigation of nonalcoholic fatty liver disease: Effects of hypoxia on mitochondrial function and lipid droplet autophagy.PloS one · 2025Article
- The Link Between Metabolic Dysfunction-Associated Steatotic Liver Disease and Gastroesophageal Reflux Disease.Cureus · 2024Review
- Impact of Sleep Fragmentation and Arousal on Nonalcoholic Fatty Liver Disease in Patients with Obstructive Sleep Apnea: A Cross-Sectional Study.Nature and science of sleep · 2024Article
- An integrated bioinformatics analysis to identify the shared biomarkers in patients with obstructive sleep apnea syndrome and nonalcoholic fatty liver disease.Frontiers in genetics · 2024Article
- Association of Obstructive Sleep Apnea with Nonalcoholic Fatty Liver Disease: Evidence, Mechanism, and Treatment.Nature and science of sleep · 2024Review
- Clinical profile, referral trends, and real-world application of vibration-controlled transient elastography in children with non-alcoholic fatty liver disease in Singapore.JGH open : an open access journal of gastroenterology and hepatology · 2024Article
- The role of hypoxia-inducible factor 1α in hepatic lipid metabolism.Journal of molecular medicine (Berlin, Germany) · 2023Review
- Non-Alcoholic Fatty Liver Disease or Type 2 Diabetes Mellitus-The Chicken or the Egg Dilemma.Biomedicines · 2023Review
- Royal Jelly andFoods (Basel, Switzerland) · 2023Article
- The impact of obstructive sleep apnea on nonalcoholic fatty liver disease.Frontiers in endocrinology · 2023Review
- Management of non-alcoholic fatty liver disease patients with sleep apnea syndrome.World journal of gastroenterology · 2022Review
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
BACKGROUND &
aimsOxidative stress is proposed as a central mediator in NAFLD pathogenesis, but the specific trigger for reactive oxygen species generation has not been clearly delineated. In addition, emerging evidence shows that obesity related obstructive sleep apnea (OSA) and nocturnal hypoxia are associated with NAFLD progression in adults. The aim of this study was to determine if OSA/nocturnal hypoxia-induced oxidative stress promotes the progression of pediatric NAFLD.
methodsSubjects with biopsy proven NAFLD and lean controls were studied. Subjects underwent polysomnograms, liver histology scoring, laboratory testing, urine F(2)-isoprostanes (measure of lipid peroxidation) and 4-hydroxynonenal liver immunohistochemistry (in situ hepatic lipid peroxidation).
resultsWe studied 36 adolescents with NAFLD and 14 lean controls. The OSA/hypoxia group (69% of NAFLD subjects) had more severe fibrosis (64% stage 0-2; 36% stage 3) than those without OSA/hypoxia (100% stage 0-2), p=0.03. Higher F(2)-isoprostanes correlated with apnea/hypoxia index (r=0.39, p=0.03), % time SaO2 <90% (r=0.56, p=0.0008) and inversely with SaO2 nadir (r=-0.46, p=0.008). OSA/hypoxia was most severe in subjects with the greatest 4HNE staining (p=0.03). Increasing F(2)-isoprostanes(r=0.32, p=0.04) and 4HNE hepatic staining (r=0.47, p=0.007) were associated with worsening steatosis. Greater oxidative stress occurred in subjects with definite NASH as measured by F(2)-isoprostanes (p=0.06) and hepatic 4HNE (p=0.03) compared to those with borderline/not NASH.
conclusionsThese data support the role of nocturnal hypoxia as a trigger for localized hepatic oxidative stress, an important factor associated with the progression of NASH and hepatic fibrosis in obese pediatric patients. LAY SUMMARY: Obstructive sleep apnea and low nighttime oxygen are associated with NAFLD progression in adults. In this study, we show that adolescents with NAFLD who have OSA and low oxygen have significant scar tissue in their livers. NAFLD subjects affected by OSA and low oxygen have a greater imbalance between the production of free radicals and their body's ability to counteract their harmful effects than subjects without OSA and low oxygen. This study shows that low oxygen levels may be an important trigger in the progression of pediatric NASH.
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