S2806 Beyond Obstructive Sleep Apnea: Elevated Odds of Diverse Sleep Disorders in Metabolic Dysfunction-Associated Steatotic Liver Disease—A Large-Scale US Cohort Study

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a globally prevalent condition with systemic implications. While its association with obstructive sleep apnea is recognized, the broader burden of sleep disorders—especially across sexes—remains poorly characterized. We aimed to evaluate the odds of developing major sleep disorder categories among MASLD patients and examine sex-based variations using a nationally representative dataset. Methods: We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network. Adults (≥18 years) diagnosed with imaging-confirmed MASLD (International Classification of Diseases, Tenth Revision [ICD-10]: K75.81, K76.0) between 2010–2020 were identified. Patients with pre-existing sleep disorders or confounding neurologic/psychiatric conditions were excluded. MASLD patients (n = 175,952) were 1:1 propensity score-matched to liver disease–free controls based on demographics, metabolic comorbidities, and healthcare access variables. Sex-stratified analysis was performed on matched man and woman MASLD cohorts (n = 67,694 each). Odds ratios (OR) with 95% confidence intervals (CI) were calculated for 6 predefined sleep disorder categories. Results: MASLD was associated with significantly increased odds of multiple sleep disorders. Compared to controls, MASLD patients had higher odds of sleep-disordered breathing (OR 1.59; 95% CI, 1.54–1.64), insomnia spectrum disorders (OR 1.33; 95% CI, 1.26–1.39), circadian rhythm disorders (OR 1.79; 95% CI, 1.49–2.16), movement-related sleep disorders (OR 1.39; 95% CI, 1.28–1.51), and parasomnias (OR 1.52; 95% CI, 1.16–1.98). No significant association was found with hypersomnia (OR 1.13; 95% CI, 0.78–1.64). Among MASLD patients, men had higher odds of sleep-disordered breathing (OR 1.73; 95% CI, 1.65–1.81), circadian rhythm disorders (OR 1.36; 95% CI, 1.03–1.78), and parasomnias (OR 1.82; 95% CI, 1.19–2.78). Women had greater odds of insomnia (OR 0.88; 95% CI, 0.82–0.95) and movement-related sleep disorders (OR 0.82; 95% CI, 0.72–0.92). No sex-based difference was observed for hypersomnia (OR 0.91; 95% CI, 0.50–1.67). Conclusion: MASLD is independently associated with increased odds of a broad range of sleep disorders beyond obstructive sleep apnea. Sex-based differences suggest men are more prone to breathing and parasomnia-related issues, while women are more affected by insomnia and movement-related disorders. These findings highlight the need for integrated and sex-specific sleep assessments in MASLD management.