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February 28, 2026Open Access

Assessing metabolic-dysfunction associated steatotic liver disease in patients with obstructive sleep apnea: a cross-sectional study

Key Points

This study aims to evaluate the prevalence and severity of metabolic-dysfunction associated steatotic liver disease among patients with obstructive sleep apnea.
Cross-sectional design involving patients with polysomnography-confirmed obstructive sleep apnea.
Participants underwent vibration-controlled transient elastography to assess hepatic steatosis and liver fibrosis.
Key measures included Controlled Attenuation Parameter (CAP) scores for steatosis and Liver Stiffness Measurement (LSM) for fibrosis.
79.2% of the cohort were diagnosed with metabolic-dysfunction associated steatotic liver disease.
45.8% had advanced steatosis and 20.8% exhibited significant fibrosis.
No significant difference in MASLD prevalence between CPAP users and CPAP-naïve patients was found.

Abstract

To assess the prevalence and severity of metabolic-dysfunction associated steatotic liver disease (MASLD) in patients with obstructive sleep apnea (OSA) initiating continuous positive airway pressure (CPAP) therapy. 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. 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 (n = 16, 22.2%), MASLD prevalence (75.0%) did not differ significantly from CPAP-naïve patients (80.4%, p = 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. 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. 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.

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