ArticleHepatology international2026
Obstructive sleep apnea mediates the association between body mass index and metabolic dysfunction-associated steatotic liver disease in patients with obesity.
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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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.
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