Abstract: Objective To investigate the risk factors of elevated liver enzymes and nonalcoholic fatty liver disease(NAFLD) in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods A total of 162 OSAHS patients admitted to Beijing Shunyi District Hospital affiliated to Capital Medical University from July 2017 to July 2019 were selected and divided into a group of 68 patients with elevated liver enzymes and a group of 94 patients with normal liver enzymes. Patients with or without NAFLD were divided into a NAFLD group of 56 patients and a non-NAFLD group of 106 patients. The risk factors affecting OSAHS liver injury were analyze. Results In the elevated liver enzymes group, the AHI, ODI, CT90, BMI, ESS score, ALT, GGT total apnea time were significantly higher than those in the normal liver enzymes group(all P<0.05), and the LSaO₂ was significantly lower than that in the normal liver enzymes group(P<0.01). The sleep apnea hypopnea index(AHI), oxygen loss index(ODI), duration of blood oxygen saturation below 90%(CT90), body mass index(BMI), ESS score, and total apnea duration in the NAFLD group were significantly higher than those in the non-NAFLD group(all P<0.05), and the minimum oxygen saturation(LSaO₂) was significantly lower than that in the non-NAFLD group(P<0.01). The ODI and LSaO₂ were independent risk factors for liver enzyme elevation(OR_ODI=1.184; OR_LSaO2=1.091; all P<0.001). The BMI, ODI and CT90 were independent risk factors for OSAHS associated NAFLD(OR_BMI=1.395; OR_ODI=1.274; OR_CT90=1.295; all P<0.001). Conclusion The ODI and LSaO₂ are independent risk factors for liver enzyme elevation in OSAHS patients, while the BMI, ODI and CT90 are independent risk factors for OSAHS patients with NAFLD.