Background/Aims Obstructive sleep apnea (OSA) among patients with nonalcoholic fatty liver disease (NAFLD) has an emerging increased trend, thus noninvasive screening methods are urgently needed to screen for OSA risk in these patients. Therefore, we aimed to screen them while conducting an office-based survey of hepatic steatosis. The routine hepatic check-up methods, such as controlled attenuation parameter (CAP) and hepatic steatosis index (HSI) in patients with or without OSA, are investigated and developed the screening model to detect OSA.

Methods The medical records of all adult patients (aged ≥ 18 years) receiving routine liver sonography examination from June 2017 to June 2020 with completed CAP, polysomnography, and HSI data in our hospital were retrospectively reviewed.

Results A total of 59 patients were included in this study. Among them, 62.7% (37/59) and 74.6% (44/59) (detected by HSI and CAP, respectively) had NAFLD, and 78% (46/59) were diagnosed with OSA- based on standard in-laboratory polysomnography. Binary logistic regression models showed that sex (male, odds ratio 4.17 [95% CI: 1.76-298.92]), body mass index (BMI) (> 24.8, odds ratio 1.42 [95% CI: 1.09-1.86]), and HSI (> 38.3, odds ratio 1.17 [95% CI: 1.02-1.36]) significantly screening OSA risk, in descending order of odds ratio. Multivariate analysis showed that male sex, BMI, and HSI independently screen OSA and their combination best screen for OSA risk (sensitivity = 78%; specificity = 85%; and positive and negative predictive values = 95% and 52%, respectively; area under the curve = 0.85).

Conclusions Our result suggests that HSI has better screening performance than CAP. A combination of male, BMI, and HSI proposed here provides a noninvasive and rapid screening tool for OSA risk. The model can be employed while patients receive routine hepatic check-ups in clinical practice. That can be used to efficiently screen for at-risk patients, and thus facilitate earlier detection and timely treatment intervention.