Fragmented Nocturnal Sleep May Play Role in Pathogenesis of MASLD

Compared with healthy individuals, patients with metabolic dysfunction-associated steatotic liver disease (MASLD) have longer nocturnal wakefulness, more fragmented sleep, and lower sleep efficiency, according to study findings published in Frontiers in Network Physiology.

While subjective data are available on the poor sleep quality among patients with MASLD vs healthy individuals, studies using more objective assessment tools to understand sleep and circadian rhythm disorders are limited.

Researchers determined sleep patterns in patients with MASLD vs those with cirrhosis of other origins and healthy individuals, using actigraphy and sleep questionnaires.

Eligible study participants had biopsy-proven MASLD or liver cirrhosis of other origins. A control group of healthy individuals was also included in the analysis.

All participants were followed-up with for 4 weeks after study enrollment. The study period was divided into actigraphy phase 1 (baseline to week 2) and phase 2 (week 2 to week 4). Data on medical history, vital signs, medication usage, blood count, and liver elastography were collected at baseline and at the end of the study. Sleep questionnaires and a daily sleep diary were completed by participants.

Actigraphy was used to calculate parameters such as sleep efficiency, wakefulness after sleep onset (WASO), and total sleep time.

A total of 62 participants were included in the analysis, of whom 35 had MASLD (mean age, 58 years; men, 66%; metabolic syndrome, 80%), 11 had cirrhosis of other origins (mean age, 58 years; men, 64%), and 16 were healthy individuals (mean age, 61 years; men, 50%). Patients with MASLD vs control participants were obese, more likely to have manifestations of the metabolic syndrome, and have higher fasting glucose, insulin levels, and triglycerides.

Although there were no significant differences in bedtime, sleep latency, and sleep duration (P >.05) between the groups, actigraphy data revealed the MASLD vs control group had more night awakenings (median, 8.5 vs 5.5; P =.0036) and more prolonged WASO (median, 45.4 vs 21.3 mins; P =.004), as well as lower sleep efficiency (86.5% vs 92.8%; P =.0008).

Based on actigraphy phase 1 data, patients with MASLD vs healthy individuals had more absolute and longer diurnal sleeping episodes (median, 1 vs 0; P =.02; median, 46 vs 0 mins; P <.03, respectively).

Using subjective sleep measures (sleep questionnaires), the researchers found reduced sleep quality, including shorter sleep duration and worse sleep efficiency, in patients with MASLD vs healthy individuals.

Overall, 84% of participants completed the sleep diary, with sleep disturbances due to psychologic stress reported among more patients with MASLD than healthy individuals or those with cirrhosis (32% vs 6.25% vs 9%, respectively).

Limitations of the analysis included not accounting for differences in body mass index (BMI) between the groups, causing potential confounding; excluding patients with obstructive sleep apnea (OSA) and/or not accounting for those with undetected OSA, who are known to have decreased sleep efficiency; and the small sample size limited generalizability. 

“Further studies applying objective methods combined with subsequent interventions, such as repetitive sleep counseling sessions or melatonin supplementation, are warranted to evaluate the therapeutic potential of improving sleep efficiency in treating MASLD,” the researchers concluded.

One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.