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

Figure 1 Temporal trends of obstructive sleep apnea in metabolic dysfunction-associated fatty liver disease (2010-2024). A: Incidence. Annual incidence proportion of obstructive sleep apnea (OSA) among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) from 2010 to 2024. The purple line represents the observed incidence (%) for each year. The black dashed line represents the Sen’s slope estimate, demonstrating the monotonic upward trend identified by the Mann-Kendall test; B: Prevalence. Annual prevalence of OSA among individuals with MASLD from 2010 to 2024. The purple line displays observed prevalence (%) each year while the black dashed line shows the Sen’s slope trend line based on non-parametric trend estimation. Statistical significance of temporal trends was evaluated using the Mann–Kendall test. OSA: Obstructive sleep apnea; MASLD: Metabolic dysfunction-associated steatotic liver disease.

Figure 2 Kaplan-Meier curves comparing obstructive sleep apnea-free probability between metabolic dysfunction–associated steatotic liver disease and non-metabolic dysfunction-associated steatotic liver disease populations. Kaplan–Meier survival curves demonstrating obstructive sleep apnea (OSA)-free probability over time among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) compared with a propensity-matched cohort without MASLD. Vertical dashed lines indicate key timepoints at which OSA-free probabilities diverge: 189 days for the MASLD cohort and 358 days for the non-MASLD cohort. The non-MASLD cohort showed consistently higher OSA-free probability across the follow-up period. The hazard ratio for the comparison was 1.152 (95%CI: 1.130-1.174) with a log-rank P < 0.0001, indicating a statistically significant difference between groups. OSA: Obstructive sleep apnea; MASLD: Metabolic dysfunction-associated steatotic liver disease.