S2763 The Impact of Obstructive Sleep Apnea on Hospitalized Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease: Insights From a Nationwide Cohort

Introduction: Obstructive sleep apnea syndrome (OSA) has been increasingly recognized as a key comorbidity in metabolic dysfunction-associated steatotic liver disease (MASLD). OSA contributes to systemic inflammation, insulin resistance, endothelial dysfunction, and sympathetic overactivation, all of which may impact hepatic and cardiovascular outcomes. However, literature evaluating the interplay of OSA and MASLD remains limited. The aim of this study was to evaluate the impact of OSA in MASLD patients using large-scale real-world data. Methods: We analyzed the Nationwide Inpatient Sample database from 2012 to 2021, identifying adult hospitalizations with MASLD using ICD-9/10-CM codes. Patients were stratified by the presence of OSA. Demographics, comorbidities, and clinical outcomes were compared between groups using appropriate statistical tests using R software. Results: Among 6,331,909 MASLD hospitalizations, 1,015,555 (16.0%) had concomitant OSA. Compared to non-OSA group, patients with MASLD in OSA group had slightly older age (median age 62 vs 61 years; P < 0.001) and a higher proportion of men (50.8% vs 47.0%; P < 0.001). The OSA group demonstrated significantly higher rates of diabetes (31.5% vs 23.9%), hypertension (66.7% vs 56.8%), acute coronary syndrome (23.3% vs 16.5%), chronic kidney disease (23.0% vs 18.9%), arrhythmias (25.1% vs 17.0%), venous thromboembolism (9.3% vs 7.2%), anxiety (20.4% vs 14.8%), and depression (21.4% vs 14.0%) (all P < 0.001). Additionally, OSA patients had lower rates of acute liver failure (8.1% vs 10.7%), alcohol use (4.2% vs 10.1%), mechanical ventilation (4.1% vs 4.6%), and liver transplantation (0.16% vs 0.21%). Despite their higher comorbidity burden, OSA patients experienced lower in-hospital mortality (2.6% vs 3.7%; P < 0.001), shorter length of stay (median 4 vs 4 days; P < 0.001), and slightly reduced hospitalization charges (median $41,755 vs $39,166; P < 0.001). Conclusion: While MASLD patients with OSA exhibited a heavier cardiometabolic burden, they paradoxically had lower inpatient mortality. This may reflect earlier detection, more aggressive management, or adaptive responses to intermittent hypoxia that blunt acute illness severity. Alternatively, OSA may serve as a marker for heightened healthcare engagement. These findings highlight the need for longitudinal studies to elucidate the interplay between OSA, MASLD progression, and outcomes.