Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is becoming increasingly common globally, exacerbated by rising obesity rates and sedentary lifestyles. MASLD is now the most prevalent liver disorder, affecting 30% of adults and 7% to 14% of children and adolescents. Projections suggest that by 2040, over 55% of adults may be affected. Individuals with MASLD are at a significantly increased risk of developing a range of serious health issues, including diabetes, hepatocellular carcinoma, other non-liver cancers, chronic kidney disease, sarcopenia (age-related muscle loss), and cardiovascular disease.
Previous research has pointed to disruptions in the circadian rhythm and sleep patterns as contributing factors in the onset of MASLD. The American Academy of Sleep Medicine, recognizing the need for more definitive evidence, has recommended the use of objective diagnostic methods over subjective tools like sleep questionnaires to establish the connection between sleep and circadian rhythm disorders and the development of MASLD and its more severe form, MASH (metabolic-associated steatohepatitis). MASH leads to liver inflammation and scarring due to excessive fat accumulation.
In a pioneering study, Dr Sofia Schaeffer, a postdoctoral researcher at the University of Basel and Basel’s University Center for Gastrointestinal and Liver Diseases, employed 24/7 actigraphy—a method that uses a wrist-worn sensor to track movement—to demonstrate distinct differences in the sleep-wake patterns of MASLD patients compared to healthy individuals. The findings, published in Frontiers in Network Physiology, revealed that MASLD patients experienced significantly more fragmented sleep due to frequent awakenings and increased wakefulness throughout the night.
From 2019 to 2021, Dr. Schaeffer and her team recruited 46 adults diagnosed with MASLD, MASH, or MASH with cirrhosis, 16 healthy volunteers, and eight patients with liver cirrhosis unrelated to MASH for comparison. Participants were outfitted with actigraphs that continuously monitored light exposure, physical activity, and body temperature. They were evaluated as outpatients at the start, midpoint, and end of a four-week follow-up period, during which they also maintained sleep diaries and completed sleep questionnaires.
The study found that while there were no significant differences in sleep duration or time spent in bed between MASLD patients and healthy individuals, MASLD patients woke up 55% more frequently and spent 113% more time awake after initially falling asleep. They also tended to sleep more during the day. Similar patterns were observed in patients with MASH and related conditions.
Subjectively, MASLD patients reported shorter, more disrupted sleep, often delayed in onset, with 32% noting sleep disturbances due to psychological stress—significantly higher than the 6% reported among healthy participants. Dr. Schaeffer concluded that sleep fragmentation appears to play a role in the pathogenesis of MASLD, though it remains unclear whether liver disease causes sleep disturbances or vice versa. The underlying mechanisms likely involve a combination of genetic, environmental, and immune response factors, all influenced by obesity and metabolic syndrome.
The study also included a single session on sleep hygiene to improve participants’ sleep patterns. Still, this intervention showed no significant impact on either actigraph-recorded or self-reported sleep quality and quantity. Dr Christine Bernsmeier, a professor at the University of Basel and the study’s senior author, suggests that future research should consider ongoing sleep counselling or interventions such as light therapy, combined with other lifestyle modifications, to enhance the sleep-wake cycles of individuals with MASLD. This comprehensive approach highlights the complex interplay between sleep, lifestyle factors, and liver health, underscoring the need for integrated treatment strategies to manage and mitigate the impacts of this increasingly prevalent liver disease.
More information: Sofia Schaeffer et al, Significant nocturnal wakefulness after sleep onset in metabolic dysfunction–associated steatotic liver disease, Frontiers in Network Physiology. DOI: 10.3389/fnetp.2024.1458665
Journal information: Frontiers in Network Physiology Provided by Frontiers
