Association between various sleep behaviors and the risk of metabolic-associated fatty liver disease: A cross-sectional analysis.

<bold>Purpose:</bold> The study aimed to comprehensively evaluate the association between various sleep behaviors and the risk of metabolic-associated fatty liver disease (MAFLD), especially the self-reported snoring. <bold>Methods:</bold> Adult patients with complete data from the National Health and Nutrition Examination Surveys (NHANES) 2017-2018 were retrospectively enrolled. The demographics, race, disease history, the results of transient elastography (Fibroscan), blood biochemical tests and sleep related data were collected and compared. Multivariate logistic regression was used to explore the independent factors for MAFLD. <bold>Results:</bold> A total of 3708 patients were enrolled, and 41.4% of individuals had MAFLD. As per the multivariate logistic regression, the self-reported snoring was independent predictors of MAFLD (p<0.001). Especially in occasionally and frequently snoring groups [OR (95% CI): 1.44 (1.12–1.87), 1.48 (1.15–1.91), p<0.001]. In addition, the levels of liver function and the incidence rates of metabolic parameters were independently associated with different severity of self-reported snoring (all p<0.05). The subgroup analyses suggested that the frequencies of snoring were independently related to the risk of MAFLD in young and middle-aged patients (both p<0.05), which was no longer associated with any frequency of self-reported snoring in the subgroup older than 60 years (p=0.400). Both in female and male subgroup, the subjects who snored frequently had a higher odds risk of MAFLD than never snoring subjects (both p<0.05). <bold>Conclusions:</bold> The self-reported snoring was an independent risk factor for MAFLD in young and middle-aged subjects. Intense monitoring and evaluation of MAFLD in such patients is necessary.