Sleep factors and metabolic dysfunction-associated steatotic liver disease in NHANES adults

Aim: Recent studies suggest an association between sleep patterns and metabolic dysfunction-associated steatotic liver disease (MASLD) among American adults. Despite established sex-specific disparities in MASLD prevalence, the potential influence of sex on the sleep-MASLD relationship is not well defined. Our research aims to elucidate the sex-specific associations of sleep with MASLD by utilizing a nationally representative cohort from the United States. Methods: Data from United States adults aged 20 and older in the 2017–2020 NHANES were analyzed in this cross-sectional study. Sleep parameters were assessed via interviewer-administered questionnaires, while MASLD was defined using vibration-controlled transient elastography (VCTE). Sex-specific associations were investigated with sex-stratified multivariable logistic regression models, and their robustness was tested through subgroup and sensitivity analyses. Results: This study included 5,243 participants (51.2% female). A significant association was observed between sleep disorders and a greater likelihood of MASLD among male participants (OR = 1.50; 95% CI: 1.08–2.10). After full adjustment for covariates, the association remained significant in females (OR = 1.51; 95% CI: 1.06–2.16). Conversely, high sleep debt remained significantly associated with MASLD in both sexes (males: OR = 1.64; 95% CI: 1.14–2.37; females: OR = 1.51; 95% CI: 1.06–2.15). Subgroup analyses confirmed that sex did not modify these relationships. Conclusions: Sleep disorders and sleep debt were significantly associated with MASLD in both sexes. These findings suggest that sleep health may represent an important modifiable target in MASLD prevention strategies.