Metabolic dysfunction–associated fatty liver disease increases the risk of sleep abnormalities: an analysis of the National Health and Nutrition Examination Survey 2017–2020

BACKGROUND: The connection between metabolic dysfunction-associated fatty liver disease (MAFLD) and sleep issues remains unclear. This study seeks to explore the relationship between sleep duration, associated disorders, and MAFLD. METHODS: A cross-sectional study utilized data from the National Health and Nutrition Examination Survey spanning from 2017 to March 2020. The MAFLD cohort was characterized by the presence of hepatic steatosis (controlled attenuation parameter ≥ 264) and metabolic dysfunction based on international guidelines. Exclusion for participants under 18 years old, those with incomplete elastography tests, heavy alcohol users, positive hepatitis C virus and hepatitis B virus status, or those lacking necessary data for MAFLD diagnosis or the sleep questionnaire. Logistic regression analysis was employed to identify significant risk factors for sleep abnormalities. RESULTS: The prevalence of MAFLD was found to be 41.4%. Participants diagnosed with MAFLD experienced shorter sleep duration, snoring, and snoring that included breathing difficulties, and increased daytime sleepiness. When controlling for age, sex, and ethnicity, MAFLD emerged as an independent risk factor for abnormal sleep duration [odds ratio (OR): 1.7, 95% confidence interval (CI): 1.5-2.1, P < 0.001], sleep troubles (OR: 1.4, 95% CI: 1.2-1.7, P < 0.001), daytime sleepiness (OR: 1.23, 95% CI: 1.05-1.4, P = 0.007), and snoring (OR: 1.2, 95% CI: 1.02-1.5, P = 0.02), as well as snoring associated with breathing difficulties (OR: 1.3, 95% CI: 1.05-1.7, P = 0.04). CONCLUSION: MAFLD increases the risk of shorter sleep duration and various sleep disorders. Further research is required to elucidate the mechanisms mediating this association.