Poor Sleep and Long Naps Linked to Higher MASLD Risk

Key Takeaways

• Among 1,900 adults aged 18 to 85 years with type 2 diabetes followed for an average of 3.2 years, adverse nocturnal sleep behaviors were associated with higher metabolic dysfunction-associated steatotic liver disease risk, with reported hazard ratios ranging from 1.64 to 2.26.
• Compared with good nocturnal sleep pattern plus short nap, metabolic dysfunction-associated steatotic liver disease risk was higher with good nocturnal sleep pattern plus long nap (HR 1.88), poor nocturnal sleep pattern plus short nap (HR 2.54), and poor nocturnal sleep pattern plus long nap (HR 3.51).
• In adults with type 2 diabetes, naps longer than 30 minutes were associated with increased metabolic dysfunction-associated steatotic liver disease risk within the reported sleep-pattern groups (HR 1.82 and HR 1.40), and adding sleep behavior to prediction models was associated with a net reclassification improvement of 0.21 and an integrated discrimination improvement of 0.06.

Poor nocturnal sleep pattern plus long nap was associated with a 3.51-fold higher risk of metabolic dysfunction-associated steatotic liver disease than good nocturnal sleep pattern plus short nap in adults with type 2 diabetes, according to Meng Zhu and colleagues in a Diabetology & Metabolic Syndrome study. The findings pointed to a broader pattern in which several adverse sleep characteristics were associated with higher MASLD risk in adults with type 2 diabetes.

The cohort included 1,900 adults with type 2 diabetes aged 18 to 85 years who were followed for an average of 3.2 years, and Zhu is affiliated with the First Affiliated Hospital of Wenzhou Medical University in China. The investigators linked MASLD risk to combined nocturnal sleep pattern and nap duration categories and more broadly to four nocturnal sleep factors and napping duration, indicating that the association extended across multiple dimensions of sleep behavior.

The authors also reported that sleep-mode addition to the Fatty Liver Index was associated with a net reclassification improvement of 0.21 and an integrated discrimination improvement of 0.06. In the investigators' interpretation, sleep behavior may help identify populations with type 2 diabetes at higher risk for MASLD.

Clinician Questions

How much higher was MASLD risk with poor nocturnal sleep and long naps in adults with type 2 diabetes?

Among 1,900 adults aged 18 to 85 years with type 2 diabetes followed for an average of 3.2 years, poor nocturnal sleep pattern plus long nap was associated with higher MASLD risk than good nocturnal sleep pattern plus short nap, with a reported hazard ratio of 3.51.

Were naps longer than 30 minutes linked to MASLD risk in adults with type 2 diabetes even within the reported sleep-pattern groups?

Naps longer than 30 minutes were associated with increased MASLD risk in adults with type 2 diabetes within the reported good nocturnal sleep and poor nocturnal sleep groups, with hazard ratios of 1.82 and 1.40, respectively.

Did adding sleep modes to the Fatty Liver Index improve MASLD risk prediction in adults with type 2 diabetes?

In adults with type 2 diabetes, incorporating sleep modes into the Fatty Liver Index was associated with a net reclassification improvement of 0.21 and an integrated discrimination improvement of 0.06.

What sleep-related factors were associated with MASLD in adults with type 2 diabetes?

The investigators reported four nocturnal sleep factors and napping duration as positively related to MASLD in adults with type 2 diabetes, with hazard ratios for adverse sleep behaviors ranging from 1.64 to 2.26.