Metabolic dysfunction–associated steatotic liver disease and obstructive sleep apnea: A cohort analysis of prevalence and hepatic outcomes

doi:10.4292/wjgpt.v17.i2.118130

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Publication Name

World Journal of Gastrointestinal Pharmacology and Therapeutics

ISSN

2150-5349

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Pharmacol Ther. Jun 5, 2026; 17(2): 118130
Published online Jun 5, 2026. doi: 10.4292/wjgpt.v17.i2.118130

Metabolic dysfunction–associated steatotic liver disease and obstructive sleep apnea: A cohort analysis of prevalence and hepatic outcomes

Rishi Chowdhary, Geng-Qing Song, Manjeet Kumar Goyal, Ashita Rukmini Vuthaluru, Kirti Arora, Rahul Chowdhary, Megh Patel, Akash Batta, Thai-Hau Koo, Venkata Sunkesula, Rohit Goyal, Omesh Goyal

Rishi Chowdhary, Department of Medicine, MetroHealth Medical Center, Cleveland, OH 44109, United States

Geng-Qing Song, Venkata Sunkesula, Department of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, United States

Manjeet Kumar Goyal, Kirti Arora, Department of Internal Medicine, Cleveland Clinic Akron General Hospital, Akron, OH 44308, United States

Manjeet Kumar Goyal, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India

Ashita Rukmini Vuthaluru, Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India

Rahul Chowdhary, Department of Internal Medicine, Cleveland Clinic Main Campus, Cleveland, OH 44106, United States

Megh Patel, Department of Medicine, B. J. Medical College, Ahmedabad 380016, Gujarāt, India

Akash Batta, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India

Thai-Hau Koo, Gastrointestinal Function and Motility Unit, Hospital Pakar Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian 16150, Kelantan, Malaysia

Rohit Goyal, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, United States

Omesh Goyal, Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India

Co-first authors: Rishi Chowdhary and Geng-Qing Song.

Author contributions: Chowdhary Ri and Song GQ designed the methodology, generated the visualization of data and writing of the original manuscript draft, provided equal contributions as detailed below, meriting co-first authorship; Chowdhary Ri, Song GQ, and Goyal MK conceptualized the study; Vuthaluru AR, Arora K, Chowdhary Ra, Patel M, Koo TH, Sunkesula V, Batta A, and Goyal R performed the investigation and data collation; all authors performed editing of the subsequent versions of the manuscript; Goyal O and Goyal MK provided the study supervision and data validation; all authors read and approved the final version of the manuscript.

AI contribution statement: Only a small number of language editors used AI-based tools (such as Grammarly). Any part of the manuscript (abstract, introduction, materials and methods, results, discussion or conclusion) was not generated by AI. All scientific content was written by the authors and underwent strict review. AI tools were only used for basic grammar correction and language optimization. No AI tools were used for data analysis or content generation. AI tools did not play a role in research design, data interpretation or conclusion formation. Any images in the manuscript were not generated by AI. We confirm that all authors are fully responsible for the integrity and originality of the manuscript.

Institutional review board statement: This study utilized de-identified TriNetX data; Institutional Review Board approval was not required.

Informed consent statement: This study utilized de-identified TriNetX data; consent was not required.

Conflict-of-interest statement: The authors declare no conflicts of interest.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.

Data sharing statement: The data that supports the findings of this study are openly available in TriNetX at https://trinetx.com.

Corresponding author: Manjeet Kumar Goyal, MD, Department of Internal Medicine, Cleveland Clinic Akron General Hospital, 1 Akron General Avenue, Akron, OH 44308, United States. manjeetgoyal@gmail.com

Received: December 24, 2025
Revised: January 1, 2026
Accepted: February 5, 2026
Published online: June 5, 2026
Processing time: 154 Days and 15 Hours

Abstract

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and often coexists with obstructive sleep apnea (OSA). Emerging evidence suggests that OSA may independently accelerate liver injury in MASLD. Despite this the epidemiology and clinical significance of OSA within the population with MASLD remain incompletely understood.

AIM

To estimate the prevalence of OSA among MASLD and determine the impact of OSA on hepatic complications.

METHODS

This was a large, multicenter, population-based retrospective cohort study conducted using the TriNetX Global Health Research Network from 2010 to 2024. We identified adults with MASLD with International Classification of Diseases, Tenth Revision codes and propensity score matched (PSM) them 1:1 with adults without MASLD. Patients with any record of prior liver disease other than MASLD or OSA (G47.3x) before the MASLD index date were excluded from the study.

RESULTS

After PSM there were 364283 pairs analyzed with balanced covariates. From 2010-2024 OSA incidence and prevalence in MASLD increased more than 400-fold (P < 0.001). MASLD was associated with 54% higher odds of OSA vs matched controls (odds ratio: 1.54), and patients with MASLD developed OSA earlier (median 189 days vs 358 days; P < 0.001). OSA markedly worsened hepatic outcomes. The odds of fibrosis were 1.78-fold higher at 1 year and 2.12-fold higher at 10 years while cirrhosis risk was 50%-55% higher at the 1-year and 10-year follow-ups (P < 0.001). Independent predictors of OSA in MASLD included male sex, obesity, older age, hypertension, and nicotine dependence.

CONCLUSION

MASLD was associated with a significantly higher risk of OSA, and coexisting OSA substantially amplified long-term hepatic complications. In addition, MASLD was associated with an earlier onset of OSA, highlighting the need for integrated hepatology-sleep medicine approaches and early identification and treatment of OSA in MASLD cohort may prevent the development of complications such as hepatic fibrosis and cirrhosis.

Keywords: Sleep-disordered breathing; Metabolic syndrome; TriNetX; Cirrhosis; Liver fibrosis; Intermittent hypoxia; Obstructive sleep apnea; Metabolic dysfunction-associated steatotic liver disease

Core Tip: Metabolic dysfunction-associated steatotic liver disease (MASLD) and obstructive sleep apnea (OSA) often coexist due to shared risk factors. Furthermore, OSA can lead to liver complications. In this large multicenter study, patients with MASLD had a significantly higher prevalence of OSA and an earlier onset of OSA. Coexisting OSA markedly increased the long-term risk of developing hepatic fibrosis and cirrhosis. These findings highlight the importance of routine OSA screening in patients with MASLD and support integrated metabolic and sleep-focused management to prevent hepatic disease progression.