Insulin resistance, in turn, promotes the development and severity of OSA through multiple mechanisms: it can lead to altered ventilatory control, contribute to visceral adiposity which mechanically impedes upper airway patency, and potentially impair the neuromuscular control of the upper airway.[25,26] Conversely, OSA itself may exacerbate liver injury and further elevate the ALT/AST ratio, creating a vicious cycle. The gene discussed is GPT; the disease is obstructive sleep apnea syndrome.