ISCHEMIC HEPATITIS DUE TO OBSTRUCTIVE SLEEP-APNEA

The case of an obese patient who developed massive centrilobular liver cell necrosis, severe coagulopathy, acute renal failure, and encephal opathy is presented. Hypovolemia and heart failure were absent, but th e acute liver disease was associated with severe arterial hypoxemia du e to obstructive sleep apnea that was shown by the nocturnal blood oxy gen desaturation, the results of the polysomnographic study, and norma l baseline pulmonary function tests. In this obese patient, liver cell necrosis was caused by severe liver cell hypoxia secondary to severe arterial hypoxemia as a consequence of obstructive sleep apnea associa ted with a Pickwickian syndrome. This observation is consistent with t he hypothesis that liver ischemia was directly related to severe arter ial hypoxemia.