J Gastrointestin Liver Dis, December 2021 Vol. 30 No 4: 477-484 1) University of Belgrade, Faculty of Medicine, Belgrade; 2) Dr. Dragiša Mišović– Dedinje Clinical and Hospital Center, Dept. of Gastroenterology, Belgrade; 3) Clinic for Psychiatry, Clinical Center of Serbia, Belgrade; 4) Niko Miljanić Institute of Anatomy, Belgrade; 5) University of Belgrade, Faculty for Sports and Physical Education, Belgrade; 6) Dr. Dragiša Mišović– Dedinje Clinical and Hospital Center, Dept. of Haematology, Belgrade; 7) Bezanijska Kosa Clinical and Hospital Center, Bezanijska s/n, Belgrade, Serbia Address for correspondence: Branka Filipovic, Assoc. Prof. Dr Dragisa Misovic-Dedinje Clinical and Hospital Center, Heroja Milana Tepica 1, 11000 Belgrade, Serbia branka.flipovic3@gmail.com Received: 27.02.2021 Accepted: 16.07.2021 Te Role of Psychotherapy in the Treatment of Patients with Non– alcoholic Fatty Liver Disease and Obstructive Sleep Apnea Branka F. Filipović 1,2 , Milan Latas 1,3 , Stanimir Kiurski 2 , Dzemal Al Kiswani 2 , Nataša Filipović 2 , Marija Marjanović– Haljilji 2 , Darko Laketic 1,4 , Milan Aksic 1,4 , Branka Marković 5 , Sunčica Kapor 6 , Slobodan Kapor 1,4 , Olivera Markovic 1,7 , Ana Starčević 1,4 INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) has been recognized as a growing global public health problem, afecting 6-45% of the general population, rising up to 70% in patients with type 2 diabetes mellitus or 90% in morbidly obese patients [1]. NAFLD is the most frequent cause of liver disease in the Western world and among the leading causes of liver cirrhosis [1], hepatocellular carcinoma [2] and liver transplantation [3]. Obesity, on the other side, is a disease with an established ORIGINAL PAPER DOI: http://dx.doi.org/10.15403/jgld-3758 ABSTRACT Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is a metabolic disease with extensive multi- organ involvement, whose extra-hepatic manifestations include diabetes mellitus type 2, cardiovascular disease, obstructive sleep apnea (OSA), chronic kidney disease, and polycystic ovary syndrome. Our hypothesis was that there was a strong psychological component in NAFLD and OSA sufering patients and that psychotherapy would be helpful in the treatment of the mentioned diseases. Methods: Of 144 initially selected patients (with NAFLD, obesity and OSA), 32 patients agreed to undergo psychotherapy, and 31 therapy-naive NAFLD and OSA patients agreed to participate as controls. Results: Psychological evaluation revealed that self-esteem rose signifcantly afer one-year psychotherapy (p=0.005). Body mass index (BMI) was signifcantly lower afer psychotherapy, followed by the changes in laboratory results. Binomial logistic regression revealed that the reduction of BMI in high probability led to self-esteem improvement (p=0.03). Conclusions: Psychotherapy was an efcient supporting method in the treatment of patients with NAFLD, obesity and OSA. It raised self-esteem and stimulated the motivation for further treatment of obesity, as one of the important factors for NAFLD and OSA. Still, it is advisable to use psychotherapy in combination with other clinical methods of treatment. Key words: non-alcoholic fatty liver disease – sleep apnea – obesity – body mass index – psychotherapy. Abbreviations: AHI: apnea-hypopnea index; BMI: body mass index; CBP: cognitive behavior psychotherapy; HDL: high-density lipoprotein; LDL: low-density lipoprotein; MRI: magnetic resonance imaging; NAFLD: non-alcoholic fatty liver disease; ODI: oxygen desaturation index; OSA: obstructive sleep apnea; PSG: polysomnography; SpO2: oxygen saturation; T2DM: diabetes mellitus type 2. association with the incidence of NAFLD, but also its severity [4-5]. Considered to be the problem of Western countries, obesity and NAFLD, in the past two decades, following urbanization in many Asian countries, has also led to a sedentary lifestyle and over nutrition, setting the stage for the epidemic of obesity [6]. Apparently, obesity is becoming a worldwide problem that causes not only medical consequences but also disturbances in psychosocial functioning. Being obese today is a great burden since contemporary societies stigmatize such persons thus making them psychologically very uncertain about their physical appearance [7]. Recent studies have demonstrated that obstructive sleep apnea (OSA) is associated with the development and evolution of NAFLD, independent or associated with obesity or other shared risk factors [8]. Obstructive sleep apnea refers to chronic intermittent hypoxia that induces the narrowing of the upper airways during sleep producing sleep fragmentation which leads to a