{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:16:34Z","timestamp":1792793794187,"version":"4.5.0"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V115B\u2010004"],"award-info":[{"award-number":["V115B\u2010004"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V115EA\u2010007"],"award-info":[{"award-number":["V115EA\u2010007"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["VTA115\u2010V1\u20106\u20101"],"award-info":[{"award-number":["VTA115\u2010V1\u20106\u20101"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V115C\u2010023"],"award-info":[{"award-number":["V115C\u2010023"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V115EA\u2010004"],"award-info":[{"award-number":["V115EA\u2010004"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 114\u20102314\u2010B\u2010075\u2010009"],"award-info":[{"award-number":["NSTC 114\u20102314\u2010B\u2010075\u2010009"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 112\u20102314\u2010B\u2010A049\u2010043\u2010MY3"],"award-info":[{"award-number":["NSTC 112\u20102314\u2010B\u2010A049\u2010043\u2010MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 114\u20102410\u2010H\u2010A49\u2010029\u2010MY2"],"award-info":[{"award-number":["NSTC 114\u20102410\u2010H\u2010A49\u2010029\u2010MY2"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100024990","name":"National Yang Ming Chiao Tung University","doi-asserted-by":"publisher","award":["114Q159502"],"award-info":[{"award-number":["114Q159502"]}],"id":[{"id":"10.13039\/501100024990","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Metabolic dysfunction\u2010associated steatotic liver disease (MASLD) and obstructive sleep apnea (OSA) are comorbid conditions that synergistically increase cardiovascular risk through systemic inflammation and insulin resistance. While continuous positive airway pressure (CPAP) is the standard treatment for OSA, its efficacy in improving hepatic steatosis and insulin resistance in patients with concurrent MASLD remains unclear. This study aims to characterize metabolic profiles in patients with MASLD stratified by OSA severity and evaluate the longitudinal effects of CPAP therapy on hepatic steatosis and insulin resistance. This retrospective cohort study screened 2429 adults and analyzed 321 patients with computed tomography\u2010confirmed MASLD who underwent polysomnography (PSG) at a tertiary center. Participants were stratified by OSA severity by using the apnea\u2013hypopnea index (AHI). The 4\u2010year longitudinal trajectories of hepatic steatosis were evaluated by employing the hepatic steatosis index (HSI) and those of insulin resistance were investigated by using the triglyceride\u2010to\u2010high\u2010density lipoprotein cholesterol (TG:HDL) ratio and triglyceride\u2010glucose (TyG) index. Moreover, the effects of CPAP therapy on these metabolic indicators were assessed. Compared with other participants, those with severe OSA (AHI \u2265\u200930) exhibited a significantly higher prevalence of elevated HSI at baseline (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and consistently higher longitudinal levels of HSI, TG:HDL, and TyG over the four\u2010year follow\u2010up. CPAP therapy significantly attenuated insulin resistance in the severe OSA cohort, as reflected by its reduced prevalence of elevated TyG relative to that of the nonuser cohort (27.4% vs. 31.9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.043). Longitudinal assessment further identified that CPAP users maintained significantly lower TyG\u2013body mass indices during the first\u2013second year (135.7 vs. 146.6,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.025) and second\u2013third year (133.6 vs. 146.0,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.036) intervals, indicating a sustained metabolic benefit. In conclusion, severe OSA significantly exacerbates metabolic dysfunction in patients with MASLD, necessitating PSG for accurate diagnosis. Long\u2010term CPAP therapy effectively improves insulin resistance specifically in severe OSA cases. Therefore, routine OSA screening and CPAP intervention based on OSA severity are strategies for improving metabolic prognosis in patients with MASLD.\n                  <\/jats:p>","DOI":"10.1002\/kjm2.70222","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:06:31Z","timestamp":1777460791000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy of\n                    <scp>CPAP<\/scp>\n                    Therapy on Liver Steatosis and Insulin Resistance in Fatty Liver Patients With Obstructive Sleep Apnea: A 4\u2010Year Follow\u2010Up Cohort Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8637-2937","authenticated-orcid":false,"given":"Hsiao\u2010Chin","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Medical Education Taipei Veterans General Hospital  Taipei Taiwan"},{"name":"Department of Chest Medicine Taipei Veterans General Hospital  Taipei Taiwan"},{"name":"School of Medicine National Yang Ming Chiao Tung University  Taipei Taiwan"},{"name":"Institute of Microbiology and Immunology, School of Life Sciences National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen\u2010Hsun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Medical Education Taipei Veterans General Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu\u2010Hao","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine Shin Kong Wu Ho\u2010Su Memorial Hospital  Taipei Taiwan"},{"name":"School of Medicine, College of Medicine Fu Jen Catholic University  New Taipei City Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih\u2010Hsun","family":"Wu","sequence":"additional","affiliation":[{"name":"Interdisciplinary Artificial Intelligence Center National Chengchi University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Wei","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Management Information Systems National Chengchi University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiao\u2010Yun","family":"Yeh","sequence":"additional","affiliation":[{"name":"Department of Medical Education Taipei Veterans General Hospital  Taipei Taiwan"},{"name":"School of Medicine National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung\u2010Cheng","family":"Tsai","sequence":"additional","affiliation":[{"name":"School of Medicine National Yang Ming Chiao Tung University  Taipei Taiwan"},{"name":"Division of Allergy, Immunology, Rheumatology, Department of Medicine Taipei Veterans General Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3889-7004","authenticated-orcid":false,"given":"Chien\u2010Wei","family":"Su","sequence":"additional","affiliation":[{"name":"School of Medicine National Yang Ming Chiao Tung University  Taipei Taiwan"},{"name":"Division of General Medicine, Department of Medicine Taipei Veterans General Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun\u2010Ta","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Chest Medicine Taipei Veterans General Hospital  Taipei Taiwan"},{"name":"School of Medicine National Yang Ming Chiao Tung University  Taipei Taiwan"},{"name":"Center of Sleep Medicine Taipei Veterans General Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7719-0397","authenticated-orcid":false,"given":"Ying\u2010Ying","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Medical Education Taipei Veterans General Hospital  Taipei Taiwan"},{"name":"School of Medicine National Yang Ming Chiao Tung University  Taipei Taiwan"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Taipei Veterans General Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming\u2010Chih","family":"Hou","sequence":"additional","affiliation":[{"name":"School of Medicine National Yang Ming Chiao Tung University  Taipei Taiwan"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Taipei Veterans General Hospital  Taipei 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J.","year":"2025","journal-title":"European Respiratory Journal"}],"container-title":["The Kaohsiung Journal of Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/kjm2.70222","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/kjm2.70222","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/kjm2.70222","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:06:38Z","timestamp":1777460798000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/kjm2.70222"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":40,"alternative-id":["10.1002\/kjm2.70222"],"URL":"https:\/\/doi.org\/10.1002\/kjm2.70222","archive":["Portico"],"relation":{},"ISSN":["1607-551X","2410-8650"],"issn-type":[{"value":"1607-551X","type":"print"},{"value":"2410-8650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]},"assertion":[{"value":"2025-12-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70222"}}