The prevalence of (MASLD) in patients with (OSA) is 79.2%.
Advanced steatosis (S3) was observed in 45.8% of the patients assessed.
Significant fibrosis (≥ F2) was detected in 20.8% of the cohort.
Among the subgroup of patients using continuous positive airway pressure (CPAP), MASLD prevalence was 75.0%, similar to 80.4% in CPAP-naïve patients.
The study identified limitations including a small sample size and a predominantly male cohort, which may affect the generalizability of the findings.
Simplified
STUDY OBJECTIVES: To assess the prevalence and severity of (MASLD) in patients with (OSA) initiating continuous positive airway pressure (CPAP) therapy.
METHODS: In this cross-sectional study, 72 patients with polysomnography-confirmed OSA (as per American Academy of Sleep Medicine criteria) presenting to the Al-Ain Sleep Clinic were prospectively enrolled. All participants underwent MASLD assessment via vibration-controlled transient elastography (FibroScan) to quantify hepatic steatosis (Controlled Attenuation Parameter, CAP) scores and liver fibrosis (Liver Stiffness Measurement, LSM). MASLD was defined as CAP ≥ 238 dB/m, advanced steatosis as CAP ≥ 290 dB/m while fibrosis was identified if LSM ≥ 7.5 kPa, and advanced fibrosis if LSM ≥ 14 kPa.
RESULTS: The cohort was predominantly male (83.3%) with mean BMI 33.33 ± 6.83 kg/m² and mean apnea-hypopnea index (AHI) of 38.2 ± 21.4 events/hour. MASLD prevalence was 79.2% (57/72; 95% CI: 68.5–87.4%), with advanced steatosis (S3) present in 45.8% (33/72; 95% CI: 34.5–57.4%). Significant fibrosis (≥ F2) was detected in 20.8% (15/72; 95% CI: 12.4–31.7%) with F2 in 16.7% and F3 in 4.2% of patients. In the CPAP subgroup ( = 16, 22.2%), MASLD prevalence (75.0%) did not differ significantly from CPAP-naïve patients (80.4%, = 0.65), though this analysis had limitations due to sample size, cross-sectional study design and lack of adherence data. Limitations include the cross-sectional design precluding causal inference, recruitment from a specialized sleep clinic introducing potential selection bias, and a predominantly male cohort (83.3%) limiting generalizability to female OSA patients. n p
CONCLUSIONS: MASLD prevalence in OSA patients substantially exceeds general population estimates, with 20.8% having significant fibrosis, underscoring the need to integrate non-invasive liver assessment into routine OSA management.
GRAPHICAL ABSTRACT: Nearly 80% of the patients with obstructive sleep apnea also have metabolic liver disease, with 46% showing advanced steatosis and 21% with significant fibrosis; far exceeding general population rates. This study establishes systematic FibroScan screening for these patients as clinical priorities, providing evidence-based risk-stratification tools for identifying high-risk patients. [Image: see text]
Key numbers
79.2%
Prevalence
Percentage of patients diagnosed with
45.8%
Advanced Steatosis Prevalence
Percentage of patients with advanced hepatic steatosis
20.8%
Significant Fibrosis Prevalence
Percentage of patients with significant liver fibrosis
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Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the United Arab Emirates University Human Medical Research Ethics Committee, with an approval number ERH_2023_3147, and with the 1964 Helsinki declaration and its later amendments. Financial disclosure: None to declare. Non-financial disclosure: None to declare. Conflict of interest: No Conflicts of Interest.
