# Sleep behaviors and metabolic-associated fatty liver disease

## TL;DR

This study found that self-reported snoring is a significant risk factor for metabolic-associated fatty liver disease, especially in younger and middle-aged individuals.

## Contribution

The study identifies self-reported snoring as an independent predictor of MAFLD and evaluates its predictive value compared to other indicators.

## Key findings

- Self-reported snoring is an independent predictor of MAFLD with odds ratios of 1.44 for occasional and 1.48 for frequent snoring.
- The predictive value of snoring for MAFLD is moderate with an ROC area of 0.638, outperforming other indicators.
- The association between snoring and MAFLD is significant in young and middle-aged patients but not in those over 60.

## Abstract

This study aimed to comprehensively evaluate the association between various sleep behaviors and the risk of metabolic-associated fatty liver disease (MAFLD), particularly self-reported snoring.

Multivariate logistic regression was used to explore independent factors associated with MAFLD. ROC curve and decision curve analyses were used to analyze and compare the different indicators.

A total of 3708 patients were enrolled, and 41.4% of them had MAFLD. According per multivariate logistic regression analysis, self-reported snoring was an independent predictor of MAFLD (p < 0.001), particularly the occasional and frequent snoring groups [OR (95% CI): 1.44 (1.12–1.87), 1.48 (1.15–1.91), p < 0.001]. In addition, the liver function levels and incidence rates of metabolic parameters were independently associated with the severity of self-reported snoring (all p < 0.05). Subgroup analyses suggested that the frequency of snoring was independently related to the risk of MAFLD in young and middle-aged patients (both p < 0.05), and was no longer associated with any frequency of self-reported snoring in the subgroup older than 60 years (p = 0.400). In both female and male subgroup, subjects who snored frequently had a higher odds risk of MAFLD than those who did not (both p < 0.05). The area under the ROC curve for snoring was 0.638, which was superior to that of the other indicators for MAFLD prediction (all p < 0.001). Meanwhile, decision curve analysis showed that snoring had a better clinical net benefit compared to other biomarkers, with a threshold probability (Pt) of approximately 0.3–0.6.

Self-reported snoring was an independent risk factor for MAFLD in young and middle-aged subjects with a moderate predictive value. Therefore, intense monitoring and evaluation of MAFLD in these patients is necessary.