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

Ali Ali Ismail; Nehad Mohamed AbdElnabi Mousa; Sami Kamal Mohamed Elgendy; Asmaa M. Al-Emrany; Orchid Saber AbdelFadil Saber; Sahar Mohamed Adel Elhakk; Dina Mohamed; Heba Ahmed Mousa Ghaleb

doi:10.5114/pm.2025.152991

eISSN: 2299-0038
ISSN: 1643-8876

Menopause Review/Przegląd Menopauzalny

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2/2025
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Original paper

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

Ali Mohamed Ali Ismail

¹

,

Nehad Mohamed AbdElnabi Mousa

²

,

Sami Kamal Mohamed Elgendy

³

,

Asmaa M. Al-Emrany

⁴

,

Orchid Saber AbdelFadil Saber

⁵

,

Sahar Mohamed Adel Elhakk

^{6, 7}

,

Dina Mohamed

^{8, 9}

,

Heba Ahmed Mousa Ghaleb

^{1, 10}

Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
Department of Physical Therapy of Musculoskeletal Disorders and it’s Surgeries, Horus University, New Damietta, Egypt
Department of Physical Therapy for Internal Medicine and Elderly, Faculty of Physical Therapy, Modern University for Technology and Information, Cairo, Egypt
Department of Physical Therapy for Internal Medicine and Geriatrics, Faculty of Physical Therapy, October University for Modern Sciences and Arts, 6th October City, Giza, Egypt
Department of Physical Therapy for Surgery and Burns, Faculty of Physical Therapy, Nahda University, Beni Suef, Egypt
Department of Basic Science, Faculty of Physical Therapy, Galala University, Suez, Egypt
Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt
Department of Physical Therapy for Women’s Health, Faculty of Physical Therapy, Galala University, Suez, Egypt
Department of Physical Therapy for Women’s Health, Faculty of Physical Therapy, Cairo University, Giza, Egypt
Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia

Menopause Rev 2025; 24(2): 94-101

DOI: https://doi.org/10.5114/pm.2025.152991

Online publish date: 2025/07/28

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AMA

Ali Ismail AM, AbdElnabi Mousa N, Mohamed Elgendy S, et al. 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. Menopause Review/Przegląd Menopauzalny. 2025;24(2):94-101. doi:10.5114/pm.2025.152991.

APA

Ali Ismail, A. M., AbdElnabi Mousa, N., Mohamed Elgendy, S., Al-Emrany, A., AbdelFadil Saber, O.,  & Adel Elhakk, S. et al. (2025). 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. Menopause Review/Przegląd Menopauzalny, 24(2), 94-101. https://doi.org/10.5114/pm.2025.152991

Chicago

Ali Ismail, Ali M, Nehad Mohamed AbdElnabi Mousa, Sami Kamal Mohamed Elgendy, Asmaa M. Al-Emrany, Orchid Saber AbdelFadil Saber, Sahar Mohamed Adel Elhakk,  and Dina Mohamed et al. 2025. "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". Menopause Review/Przegląd Menopauzalny 24 (2): 94-101. doi:10.5114/pm.2025.152991.

Harvard

Ali Ismail, A., AbdElnabi Mousa, N., Mohamed Elgendy, S., Al-Emrany, A., AbdelFadil Saber, O., Adel Elhakk, S., Mohamed, D.,  and Mousa Ghaleb, H. (2025). 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. Menopause Review/Przegląd Menopauzalny, 24(2), pp.94-101. https://doi.org/10.5114/pm.2025.152991

MLA

Ali Ismail, Ali et al. "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." Menopause Review/Przegląd Menopauzalny, vol. 24, no. 2, 2025, pp. 94-101. doi:10.5114/pm.2025.152991.

Vancouver

Ali Ismail A, AbdElnabi Mousa N, Mohamed Elgendy S, Al-Emrany A, AbdelFadil Saber O, Adel Elhakk S et al. 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. Menopause Review/Przegląd Menopauzalny. 2025;24(2):94-101. doi:10.5114/pm.2025.152991.

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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.

keywords:

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

Ali Mohamed Ali Ismail 1 , Nehad Mohamed AbdElnabi Mousa 2 , Sami Kamal Mohamed Elgendy 3 , Asmaa M. Al-Emrany 4 , Orchid Saber AbdelFadil Saber 5 , Sahar Mohamed Adel Elhakk 6, 7 , Dina Mohamed 8, 9 , Heba Ahmed Mousa Ghaleb 1, 10

weight loss, diet, polycystic ovarian syndrome, non-alcoholic fatty liver, obstructive sleep apnea

Ali Mohamed Ali Ismail

¹

,

Nehad Mohamed AbdElnabi Mousa

²

,

Sami Kamal Mohamed Elgendy

³

,

Asmaa M. Al-Emrany

⁴

,

Orchid Saber AbdelFadil Saber

⁵

,

Sahar Mohamed Adel Elhakk

^{6, 7}

,

Dina Mohamed

^{8, 9}

,

Heba Ahmed Mousa Ghaleb

^{1, 10}