Журнал клинических случаев

Case of Nonalcoholic Steatohepatitis Occurring in Combination with Sleep Apnea Syndrome, Who Showed Improvement of Liver Function by Continuous Positive Airway Pressure

Abstract

Shigefuku R, Takahashi H, Ikeda H, Matsunaga K, Koike J, Maeyama S, Matsumoto N, Okuse C, Itoh F and Suzuki M

We present a case of Nonalcoholic Steatohepatitis (NASH) occurring in combination with sleep apnea syndrome (SAS) in a 35-year-old man whose liver function improved on introduction of continuous positive airway pressure (CPAP). The patient had been steadily gaining body weight since the age of 20, and liver dysfunction had been frequently highlighted during regular health checks. He had a history of snoring, nasal obstruction, and lethargy and was admitted to our hospital for evaluation and diagnosis of these symptoms. Following Polysomnography (PSG), he was diagnosed with SAS on the basis of an apnea and hypopnea index (AHI) score of 34.7/hour. Following CPAP treatment, his symptoms gradually improved and his AHI score reduced to 3.8/hour. However, despite CPAP contributed to the improvement of Alanine Aminotransferase (ALT) and aspartate aminotransferase (AST) these levels remained elevated, and he showed sustained liver dysfunction. Therefore, we were consulted for evaluation and diagnosis of the sustained liver dysfunction. On admission, his body mass index (BMI) was 34.5 kg/m2 and abdominal Ultrasonography (US) and Computed Tomography (CT) indicated the presence of severe fatty liver. A liver biopsy was performed and the patient was diagnosed with NASH, grade 1/stage 2 and steatosis grade 3.