Along these lines, it is conceivable that the proinflammatory state observed in obese NAFLD patients may be enhanced by hypoxia, due to a positive feedback mechanism involving HIF-1α and NF-κB, explaining the exacerbation of liver injury in NAFLD subjects in the presence of obstructive sleep apnea-hypopnea syndrome (OSAHS) [162]. This evidence concerns the gene NFKB1 and metabolic dysfunction-associated steatotic liver disease.