Obstructive sleep apnea and cardiovascular disease in individuals with metabolic dysfunction‐associated fatty liver disease: A prospective cohort study

Objective To assess the association between obstructive sleep apnea (OSA) risk levels and major cardiovascular disease (CVD) subtypes in individuals with metabolic dysfunction‐associated fatty liver disease (MAFLD). Methods This cohort study included 128,022 MAFLD participants from the UK Biobank without CVD at baseline. OSA risk was assessed using the Berlin Questionnaire. Cardiovascular outcomes, including coronary heart disease (CHD), atrial fibrillation (AF), heart failure (HF), and stroke, were identified via hospital and death records. Cox proportional hazards models estimated the associations between OSA risk levels and CVD events. Results Over a median follow‐up of 13.6 years, 25,618 CVD events occurred. Compared with participants at low OSA risk, those at high OSA risk were associated with higher CHD (hazard ratios [HR], 1.10; 95% CI: 1.06–1.14) and AF (HR, 1.05; 95% CI: 1.01–1.10) after full adjustment, but not with HF (HR, 1.05; 95% CI: 0.98–1.11) or stroke (HR, 0.94; 95% CI: 0.87–1.02). Associations were strongest in overweight individuals without diabetes. No significant interaction was observed between OSA risk and genetic CVD susceptibility. Conclusion High OSA risk independently increases CHD and AF risk in MAFLD, particularly among overweight individuals without diabetes, suggesting targeted intervention may be beneficial.