ArticleScientific reports2026
Association between metabolic dysfunction-associated steatotic liver disease and obstructive sleep apnea: a nationwide retrospective cohort study.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) and obstructive sleep apnea (OSA) share overlapping metabolic and inflammatory pathways, yet population-level evidence linking MASLD and incident OSA remains limited. Using a nationwide cohort of 265,452 Korean adults aged ≥ 40 years, we evaluated OSA risk across five mutually exclusive phenotypes defined by steatosis (fatty liver index [FLI] ≥ 30), cardiometabolic risk factors (CMRFs), and alcohol intake: no steatotic liver disease (SLD) without CMRFs, no SLD with CMRFs, MASLD without alcohol, MASLD with alcohol intake below the metabolic-associated alcohol-related liver disease (MetALD) threshold (men < 210 g/week, women < 140 g/week), and MetALD. During a mean follow-up of 9.5 years, 1,025 participants developed OSA. Compared with the reference group, adjusted hazard ratios (aHRs) for OSA were 1.18 (95% confidence intervals [CI] 0.93-1.50) in individuals with CMRFs alone, 1.46 (95% CI 1.12-1.91) in MASLD without alcohol, 1.52 (95% CI 1.17-1.98) in MASLD with alcohol, and 1.40 (95% CI 1.01-1.94) in MetALD. Model-based absolute risk differences (ARDs) at 9.5 years showed consistent patterns (+ 0.05%, + 0.14%, + 0.16%, and + 0.12%, respectively). Sensitivity analyses using stricter steatosis criteria (FLI ≥ 60 or hepatic steatosis index ≥ 36) demonstrated a clearer dose-related gradient, with progressively higher OSA risk across MASLD without alcohol, MASLD with alcohol, and MetALD. These findings highlight MASLD-particularly alcohol-associated phenotypes-as important risk markers for OSA and underscore the need for targeted screening and early intervention strategies in this increasingly prevalent population.
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