Yao QH, Yang WY. Revisiting the association between metabolic dysfunction-associated steatotic liver disease and sleep: Moving from correlation to causation. World J Gastroenterol 2025; 31(45): 113115 [DOI: 10.3748/wjg.v31.i45.113115]
Corresponding Author of This Article
Wei-Yu Yang, MD, PhD, Assistant Professor, Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, Hunan Province, China. yangweiyu@csu.edu.cn
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Gastroenterology & Hepatology
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Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 7, 2025 (publication date) through Dec 6, 2025
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World Journal of Gastroenterology
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1007-9327
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Yao QH, Yang WY. Revisiting the association between metabolic dysfunction-associated steatotic liver disease and sleep: Moving from correlation to causation. World J Gastroenterol 2025; 31(45): 113115 [DOI: 10.3748/wjg.v31.i45.113115]
World J Gastroenterol. Dec 7, 2025; 31(45): 113115 Published online Dec 7, 2025. doi: 10.3748/wjg.v31.i45.113115
Revisiting the association between metabolic dysfunction-associated steatotic liver disease and sleep: Moving from correlation to causation
Qiu-Han Yao, Wei-Yu Yang
Qiu-Han Yao, College of Humanities and Development Studies, China Agricultural University, Beijing 100083, China
Wei-Yu Yang, Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Author contributions: Yao QH wrote the original draft; Yang WY contributed to conceptualization, writing, reviewing, and editing; Yao QH and Yang WY participated in drafting the manuscript; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Yu Yang, MD, PhD, Assistant Professor, Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, Hunan Province, China. yangweiyu@csu.edu.cn
Received: August 15, 2025 Revised: October 2, 2025 Accepted: November 3, 2025 Published online: December 7, 2025 Processing time: 110 Days and 15.4 Hours
Abstract
The retrospective study by Hyatt et al reported that metabolic dysfunction-associated steatotic liver disease (MASLD) with fibrosis was associated with poorer sleep, which in turn correlated with worse life quality in patients with human immunodeficiency virus. While their findings were significant, some limitations warrant consideration. First, the cross-sectional design precludes causal relationships. Second, no subgroup analyses stratified were conducted, leaving it unclear which sleep disturbances may increase MASLD risk. Third, baseline differences between groups may have introduced confounding. To address these limitations, we conducted a Mendelian randomization analysis to minimize confounding and assess the potential causal relationship between sleep traits and MASLD. Mendelian randomization results indicated that sleep apnea significantly increases the risk of MASLD (P = 0.014), whereas no causal associations were identified for other sleep traits. These findings complement and extend those of Hyatt et al, providing further insight into the association between MASLD and sleep.
Core Tip: The recent study by Hyatt et al investigated the prevalence and associations between metabolic dysfunction-associated steatotic liver disease (MASLD), poor sleep, and life quality in patients with human immunodeficiency virus. To further explore the potential causal relationship between specific sleep traits and MASLD, we conducted a Mendelian randomization analysis, which demonstrated that sleep apnea significantly increases the risk of MASLD (P = 0.014), whereas no causal associations were found for other sleep traits (P > 0.05). These findings complement and extend those of Hyatt et al, providing additional insight into the associations between MASLD and sleep.
