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Elevated Serum Aminotransferase Levels in Children at Risk for Obstructive Sleep Apnea^*

^* From the Department of Pediatrics (Drs. Kheirandish-Gozal, Sans Capdevila, and Gozal), Division of Pediatric Sleep Medicine, University of Louisville, Louisville, KY; and the Department of Infectious Diseases (Dr. Kheirandish), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.

Correspondence to: David Gozal, MD, FCCP, Kosair Children’s Hospital Research Institute, University of Louisville, 570 South Preston St, Suite 204, Louisville, KY 40202; e-mail: david.gozal{at}louisville.edu

Abstract

Background: Fatty liver disease (FLD) is a highly prevalent condition in obese (Ob) children, who are at increased risk for obstructive sleep apnea (OSA). However, the contribution of OSA to FLD remains unknown.

Design: Prospective study.

Setting: Polysomnographic evaluation and assessment of plasma levels of insulin, glucose, and lipids, and liver function tests.

Participants: A total of 518 consecutive snoring children 4 to 17 years of age who were being evaluated for habitual snoring and suspected OSA.

Results: A total of 376 children had body mass index z score of < 1.20 (non-Ob children), 3 children (<1%) had elevated serum aminotransferase (LFT) levels, and 248 had OSA (65.9%). Among the 142 overweight/Ob children, 46 had elevated LFT levels (32.4%); of these children, 42 had OSA (91.3%). In contrast, OSA was present in only 71.8% of Ob children without elevated LFT level (p < 0.01). Insulin resistance and hyperlipidemia were more likely to occur in children with FLD. Furthermore, FLD was improved after treatment of OSA in 32 of 42 Ob children (p < 0.0001).

Conclusion: Increased liver enzyme levels are frequently found in Ob snoring children, particularly among those with OSA and/or metabolic dysfunction. Effective treatment of OSA results in improved liver function test results in the vast majority of these patients.

Key Words: fatty liver • obesity • sleep apnea