Poor sleep patterns evident in people with MASLD, MASH: Study
Nighttime wakening, shorter sleep duration seen in patients vs. other adults
Troubled sleep is more common in people with metabolic dysfunction-associated steatotic liver disease (MASLD), a type of fatty liver disease, than in age-matched adults in good health, a study in Switzerland showed.
Subgroups of patients with a more severe form of MASLD — metabolic dysfunction-associated steatohepatitis (MASH) — and people with cirrhosis, where the liver is irreversibly scarred and damaged, showed similar sleep problems, as assessed by a tool to monitor movement among study participants 24 hours a day.
“Here we show for the first time with an objective method … that the sleep-wake rhythm in patients with MASLD does indeed differ from that in healthy individuals: those with MASLD demonstrated significant fragmentation of their nightly sleep due to frequent awakenings and increased wakefulness,” Sofia Schaeffer, PhD, the study’s co-first author and a postdoctoral researcher at the University of Basel, said in a news story accompanying the publication.
A single session in sleep hygiene, given at the study’s midpoint to boost sleep quality, was found to be ineffective. The researchers recommended future studies focus on repetitive counseling sessions and other ways of improving patients’ sleep.
Sleep patterns in these liver disease patients given objective measure
The study, “Significant nocturnal wakefulness after sleep onset in metabolic dysfunction-associated steatotic liver disease,” was published in Frontiers in Network Physiology.
Fatty liver disease, now known as steatotic liver disease, is characterized by an abnormal amount of fat accumulating in the liver. MASLD is a common form of this disease, wherein the fat buildup is associated with risk factors for metabolic syndrome, including obesity, high blood pressure, high blood levels of fatty molecules, and the elevated blood sugar levels marking type 2 diabetes.
Some MASLD patients go on to develop a more severe form called MASH, where inflammation and scarring start to damage the liver. These people are at a risk of advancing disease symptoms, such as cirrhosis, liver failure, or liver cancer.
Previous preclinical and clinical studies suggest a link between disturbed sleep and MASLD. But studies in patients predominately have relied on subjective measures of sleep quality, such as self-reported questionnaires.
Here, scientists used a more objective technique called actigraphy to monitor sleep patterns in 35 adults with some form of MASLD — including 16 with MASH and eight with MASH and cirrhosis — and 11 others with MASH-unrelated cirrhosis. Sixteen healthy adults of similar age were enrolled as a comparison group.
Actigraphy is a noninvasive approach for monitoring sleep-wake cycles 24 hours a day. Participants wore a wearable sensor, or actigraph, around their wrist for four weeks that collected information about light, body temperature, and physical movement.
MASLD, MASH patients woke up 55% more often than did healthy adults
All adults with MASLD or MASH were obese, and 80% had cardiometabolic risk factors. They had significantly higher levels of blood sugar and fatty molecules called triglycerides in their blood than healthy participants.
Actigraphy data showed a similar overall sleep duration and amount of time spent in bed between the patient group and healthy adults.
However, MASLD patients woke up during the night 55% more often than did healthy people, awakening a median of 8.5 times compared with 5.5 times for healthy adults. They also spent more time awake, by 113%, after having first fallen asleep.
Altogether, these differences marked a significantly lower level of sleep efficiency among MALSD patients. As a way of compensating, these people during the day fell asleep significantly more often and slept for significantly longer times.
Similarly troubled sleep patterns were evident in patients with MASH and MASH-related cirrhosis, as well as in those with MASH-unrelated cirrhosis, compared with healthy adults.
Study participants also completed sleep questionnaires and kept sleep diaries. Findings from these subjective measures generally were consistent with actigraphy findings.
MASLD/MASH patients reported shorter sleep periods and delayed sleep onset, with an overall poorer sleep quality than did healthy people. Nearly a third reported experiencing sleep disturbances caused by psychological stress, compared with 9% of the adults with MASH-unrelated cirrhosis and 6% of the adults in good health.
Overall, “these findings support previous studies suggesting that disturbances in the complex regulatory network of the sleep-wake rhythm might play an important role in the [development] of human MASLD,” the researchers wrote.
Which comes first — MASLD or troubled sleep — not quite clear
While the findings highlight a link between the liver disease and sleep disturbances, there is more to learn about this relationship.
“Whether MASLD [causes] sleep disorders or vice versa remains unknown,” Schaeffer said. “The underlying mechanism presumably involves genetics, environmental factors, and the activation of immune responses — ultimately driven by obesity and metabolic syndrome.”
MALSD patients also underwent a single sleep hygiene education session halfway through the study, where they were taught about healthy sleep habits and given recommendations for improving sleep quality. That session did not improve sleep as assessed via actigraphy and self-reported measures.
“Future studies should explore perpetual sleep counselling sessions or interventions such as light therapy in combination with other lifestyle changes to improve the sleep-wake cycle in patients with MASLD,” said Christine Bernsmeier, MD, PhD, the study’s senior author and a professor in the department of biomedicine at the University of Basel.
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