Evidence map›Paper›PMID 42236658›Full record

ArticleHepatology international2026

Obstructive sleep apnea mediates the association between body mass index and metabolic dysfunction-associated steatotic liver disease in patients with obesity.

Peikai Zhao, Juanjuan Zou, Yuxuan Li, Shaozhuang Liu, Ze-Hua Zhao, Xin Huang

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Article in Hepatology international, 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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5 · Who and what money

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6 authors.

Peikai Zhao *Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road 107#, Jinan, 250012, China.
Juanjuan Zou *Department of Otorhinolaryngology, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Qilu Hospital of Shandong University, Jinan, 250012, China.
Yuxuan LiDivision of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road 107#, Jinan, 250012, China.
Shaozhuang LiuDivision of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road 107#, Jinan, 250012, China.
Ze-Hua ZhaoDepartment of Hepatology, Qilu Hospital of Shandong University, Wenhuaxi Road 107#, Jinan, 250012, China. zhaozehua2009@126.com.ORCID http://orcid.org/0000-0002-3708-8881
Xin HuangDivision of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road 107#, Jinan, 250012, China. huangxinsdu@163.com.

Funding

National Natural Science Foundation of China 82000542National Natural Science Foundation of China 82000968National Natural Science Foundation of China 82100853Natural Science Foundation of Shandong Province ZR2020QH152Natural Science Foundation of Shandong Province ZR2021QH028Natural Science Foundation of Shandong Province ZR2024QH146
6 · The paper itself

Abstract

BACKGROUND AND

aimObstructive sleep apnea (OSA) and metabolic dysfunction-associated steatotic liver disease (MASLD) are frequently encountered in patients with obesity. The interplay of OSA, MASLD and obesity is unknown. We aimed to elucidate the role of OSA in the relationship between the severity of obesity and MASLD.

methodsWe enrolled 552 patients intending to undergo sleeve gastrectomy (SG) from January 2020 to August 2023. Biochemical parameters were detected, and sleep breathing conditions were measured before SG. Liver biopsy was performed during SG. Multiple linear regressions and logistic regressions were performed to determine the effect of OSA on MASLD. Multiple mediation analyses were conducted to elucidate the mediating role of OSA in the obesity-MASLD association.

resultsOSA severity was independently associated with liver histology, including steatosis score [odds ratio (OR) = 1.424, 95% confidence interval (CI) 1.027-1.975, p = 0.034], nonalcoholic fatty liver disease activity score (OR = 1.459, 95% CI 1.059-2.008, p = 0.021), and fibrosis stage (OR = 1.464, 95% CI 1.024-2.092, p = 0.037) after multivariable adjustment. Multiple mediation analyses revealed that mean pulse oxygen saturation (MSpO

conclusionOSA was independently associated with hepatic steatosis and MASH in patients with obesity. MSpO₂ could serve as a mediator in the obesity-MASLD association, and HDL-C exhibited a significant moderating role in this pathway. These findings highlight the necessity for the management of OSA to protect against MASLD in patients with obesity.

Indexed as

Body Mass IndexFatty LiverNon-alcoholic Fatty Liver DiseaseObesitySleep Apnea, ObstructiveAdultFemaleHumansLiverMaleMiddle AgedSeverity of Illness IndexHepatic steatosisMASHMediationObesityObstructive sleep apnea

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.