High OSA risk was independently associated with metabolic dysfunction-associated steatotic liver disease compared to low risk (OR 1.46; 95% CI 1.20-1.78; p<0.001).
Cohort (n=2,983)
Yes
Is high obstructive sleep apnea risk independently associated with metabolic dysfunction-associated steatotic liver disease in adults?
High OSA risk is independently associated with an increased likelihood of MASLD, highlighting the potential value of routine OSA screening in patients with metabolic risk factors.
Effect estimate: OR 1.46 (95% CI 1.20-1.78)
Absolute Event Rate: 56.4% vs 31.1%
p-value: p=<0.001
Abstract Rationale Obstructive sleep apnea (OSA) and metabolic dysfunction-associated steatotic liver disease (MASLD) often coexist in clinical practice. OSA causes intermittent hypoxia and oxidative stress, leading to inflammation and insulin resistance, processes implicated in MASLD pathogenesis. However, it remains unclear whether OSA independently contributes to MASLD. We aimed to evaluate the independent association between OSA risk and MASLD, beyond shared metabolic mechanisms. Methods We conducted a prospective, multi-center, population-based cohort study across three major regions in Saudi Arabia. Adults recruited from primary healthcare clinics had their anthropometric measurements, and metabolic markers collected, underwent transient elastography (FibroScan), and completed comprehensive questionnaires, including the Berlin Questionnaire for OSA risk and International Physical Activity (PA) Questionnaire. MASLD was defined as moderate-to-severe hepatic steatosis (controlled attenuation parameter ≥268 dB/m) with at least one cardiometabolic risk factor. Baseline characteristics were compared across OSA risk groups. Multivariable logistic regression was performed to assess the independent association between OSA risk and MASLD. Results We included 2,983 adults (mean age: 41.9 ± 13.3 years; males: 1,488 49.9%; median body mass index BMI: 28.8 25.2-32.7 kg/m²). Of these, 729 (24.4%) had high OSA risk and 1,111 (37.2%) had MASLD. Compared with those at low OSA risk, participants at high OSA risk were older (45.7 ± 12.6 vs. 40.7 ± 13.3 years; p 0.001), had higher median BMI (32.5 30.3-35.7 vs. 27.5 24.3-31.0 kg/m²; p 0.001), greater waist circumference (WC) (103.4 ± 13.8 vs. 91.6 ± 15.0 cm; p 0.001), and lower PA (80.4% vs. 68.9%; p 0.001). Participants at high OSA risk had significantly higher prevalence of MASLD (56.4% vs. 31.1%), diabetes (29.8% vs. 17.5%), hypertension (26.1% vs. 11.3%), and dyslipidemia (37.6% vs. 22.9%; all p 0.001) (Table 1). In multivariable analysis, high OSA risk was independently associated with MASLD (odds ratio OR: 1.46, 95% confidence interval CI: 1.20-1.78; p 0.001), along with WC per 5 cm increase (1.39, 1.34-1.44; p 0.001), male sex (1.25, 1.05-1.49; p = 0.01), and age per 10 years (1.22, 1.14-1.30; p 0.001). Higher PA was protective against MASLD (0.73, 0.63-0.85; p 0.001). Conclusions High OSA risk was independently associated with MASLD in adults, even after adjustment for demographic and metabolic covariates. This finding underscores the need for routine OSA risk assessment in individuals with MASLD to enable earlier detection and targeted prevention. Promoting PA may mitigate this risk, and future studies should explore whether treating OSA can directly improve liver health outcomes. This abstract is funded by: None
Alqahtani et al. (Fri,) conducted a cohort in Obstructive sleep apnea risk and metabolic dysfunction-associated steatotic liver disease (n=2,983). High OSA risk vs. Low OSA risk was evaluated on Metabolic dysfunction-associated steatotic liver disease (MASLD) (OR 1.46, 95% CI 1.20-1.78, p=<0.001). High OSA risk was independently associated with metabolic dysfunction-associated steatotic liver disease compared to low risk (OR 1.46; 95% CI 1.20-1.78; p<0.001).