Effect of lifestyle changes on liver enzymes, triglycerides, sex hormones, and daytime sleepiness in polycystic ovarian syndrome women with obstructive sleep apnea and fatty liver - a randomized controlled trial.

Introduction: Lifestyle changes are one of the main therapeutic approaches for women with polycystic ovarian syndrome (PCOS), non-alcoholic fatty liver disease (NAFLD), and obstructive sleep apnea (OSA). This 8-week study aimed to assess the effect of lifestyle modifications on liver enzymes, triglycerides (TG), sex hormones, and daytime sleepiness in PCOS women with NAFLD and mild and moderate OSA.

Material and methods: This study included 40 women. The included obese PCOS women with OSA and NAFLD were assigned randomly to the study group and control group (n = 20 for each PCOS group). Besides the low-calorie diet (LCD), both PCOS groups received 500 mg of metformin tablets consumed three times daily. The study group additionally received free 30-minute walking exercise daily. Besides aspartate transaminase, alanine transaminase, and TG, the following outcomes were assessed in all PCOS women with OSA and NAFLD: waist circumference, neck circumference, body mass index, waist-hip ratio, serum testosterone, ratio of luteinizing hormone and follicle-stimulating hormone, apnea-hypopnea index, dehydroepiandrosterone, and Epworth sleepiness scale (to assess excessive daytime sleepiness).

Results: A significant improvement in the value of all outcomes was achieved in both PCOS groups, but the improvements were high in the study group. Also, the designed between-group comparison of post values of PCOS women's outcomes showed a significant improvement in the study group.

Conclusions: Adding eight weeks of free-walking exercise to LCD and administration of metformin resulted in significantly greater improvements in PCOS than LCD and administration of metformin alone in women with NAFLD and OSA.