In patients with metabolic dysfunction-associated steatotic liver disease, sleep disturbance is highly prevalent and associated with a profound impairment of health-related quality of life

Document Type

Conference Proceeding

Publication Date

5-1-2025

Publication Title

J Hepatol

Abstract

Background and aims: Metabolic dysfunctional-associated steatotic liver disease (MASLD) patients have impaired health-related quality of life and other patient-reported outcomes (PROs) which can be exacerbated by comorbidities, including sleep disorders. Our aim was to assess the prevalence of sleep disturbance and its association with PROs in MASLD. Method: Patients with MASLD were prospectively enrolled into the Global NAFLD MASLD Registry™ (GNR). Clinical and PROs (FACIT-F, CLDQ-MASH, and WPAI) data were analyzed by the presence of sleep disturbance (defined as CLDQ-MASH Sleep score of ≤4 on a 1–7 scale). Results: 5342 MASLD patients from 17 countries in the GNR were included: mean (SD) age 53 (13) years, 48% male and 60% obese, 41% had type 2 diabetes (T2D), 46% hypertension, 43% hyperlipidemia, 15% with advanced fibrosis (by biopsy or FIB-4 or transient elastography), 20% depression, 52% clinically overt fatigue, 32% abdominal pain, and 20% sleep apnea. Prevalence of sleep disturbance among MASLD was 34%. MASLD patients and sleep disturbance were more commonly female (63% vs. 46%), with more components of metabolic syndrome (obesity 65% vs. 57%, T2D 47% vs. 37%, hypertension 54% vs. 42%, hyperlipidemia 51% vs. 39%), non-hepatic comorbidities (anxiety 52% vs. 24%, depression 31% vs. 13%, clinically overt fatigue 60% vs. 48%) and sleep apnea (26% vs. 16%) than those without sleep disturbance (all p < 0.01). In logistic regression model, presence of sleep disturbance in MASLD was associated with older age, female sex, history of anxiety, depression, clinically overt fatigue, abdominal pain, smoking, lack of regular exercise, and presence of significant pruritus (all p < 0.01). In MASLD patients with sleep disturbance, PRO scores in all domains of CLDQ-MASH and FACIT-F were lower (up to −25% of a score range size), and work productivity impairment was higher (mean [SD] 0.30 [0.33] vs. 0.11 [0.23]) (all p < 0.0001). In particular, the presence of sleep disturbance was strongly associated with lower fatigue scores of CLDQ-MASH and FACIT-F (more fatigue) and with lower pruritus scores (more pruritus) of CLDQ-MASH (effect size −17% to −23%, all p < 0.0001). In multiple regression analysis, sleep disturbance was independently associated with lower PRO scores in all domains of CLDQ-MASH, FACIT-F, and WPAI (beta up to −15%). Other independent predictors of lower PRO scores in MASLD included age, female sex, comorbidities (metabolic syndrome components, psychiatric disorders, clinically overt fatigue, and sleep apnea), advanced fibrosis, smoking, and lack of regular exercise (p < 0.05). Conclusion: Sleep disturbance is highly prevalent in patients with MASLD. It is associated with fatigue and pruritus, non-hepatic comorbidities, lifestyle factors, and substantial impairment in HRQL and work productivity. Patients with MASLD should be assessed for sleep disturbances and advised accordingly.

Volume

82

First Page

S680

Last Page

S681

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