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This study included 4772 subjects from the National Health and Nutrition Examination Survey data from 2017 to 2020. Poor sleep factors were defined as: \u2460abnormal sleep duration (&lt;\u20097\u00a0h or &gt;\u20098\u00a0h); \u2461snoring; \u2462sleep apnea; \u2463self-reported sleep disorder; \u2464 daytime sleepiness. The frequency of each sleep factor was scored, and the scores of all components were summed to obtain a sleep score ranging from 0 to 12. The higher the score, the less healthy the sleep pattern. Then we divided the overall sleep pattern into mild (sleep score 0\u20133 points), moderate (sleep score 4\u20137 points) or severe (sleep score 8\u201312 points) sleep pattern according to the distribution of sleep scores. Multiple logistic regression and restricted cubic spline graph analysis were used to determine the association between sleep and NAFLD\\MAFLD\\MASLD. In Model 1 and Model 2, sleep score as a continuous or categorical variable had an effect on NAFLD\\MAFLD\\MASLD(\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\n                    <jats:italic>0.05<\/jats:italic>\n                    ). The risk of NAFLD\\MAFLD\\MASLD was higher in subjects with severe sleep patterns (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009\n                    <jats:italic>0.05<\/jats:italic>\n                    ). Snoring and sleepy during day was associated with NAFLD\\MAFLD\\MASLD (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009\n                    <jats:italic>0.05<\/jats:italic>\n                    ). We then drew a restricted cubic spline plot and found that sleep duration was nonlinearly associated with MAFLD\\MASLD (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009\n                    <jats:italic>0.01<\/jats:italic>\n                    ), and the risk of MAFLD\\MASLD was lower when the sleep duration was 7.5\u2009~\u20099.5\u00a0h\/d. In this nationally representative survey, severe sleep patterns were associated with an increased risk of NAFLD\/MAFLD\/MASLD. It is worth noting that sleep duration was nonlinearly associated with MAFLD and MASLD.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-95336-9","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T04:26:04Z","timestamp":1742963164000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Multidimensional sleep impairment predicts steatotic liver disease spectrum risk"],"prefix":"10.1038","volume":"15","author":[{"given":"Dongling","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujie","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haihang","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinqiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,26]]},"reference":[{"issue":"10290","key":"95336_CR1","doi-asserted-by":"publisher","first-page":"2212","DOI":"10.1016\/S0140-6736(20)32511-3","volume":"397","author":"RINELLAM POWELL E E, WONG V W S","year":"2021","unstructured":"POWELL E E, WONG V W S, R. I. N. E. L. L. A. M. Non-alcoholic fatty liver disease[J\/OL]. Lancet 397(10290), 2212\u20132224. https:\/\/doi.org\/10.1016\/S0140-6736(20)32511-3 (2021).","journal-title":"Lancet"},{"key":"95336_CR2","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.ejim.2024.01.013","volume":"122","author":"M ZONCAP\u00c8","year":"2024","unstructured":"ZONCAP\u00c8, M., LIGUORI, A. & TSOCHATZIS, E. A. Non-invasive testing and risk-stratification in patients with MASLD[J\/OL]. Eur. J. Intern. Med. 122, 11\u201319. https:\/\/doi.org\/10.1016\/j.ejim.2024.01.013 (2024).","journal-title":"Eur. J. Intern. Med."},{"key":"95336_CR3","unstructured":"A single-letter. Change in an acronym: signals, reasons, promises, challenges, and steps ahead for moving from NAFLD to MAFLD - PubMed[EB\/OL]. [2024-08-25]. https:\/\/pubmed.ncbi.nlm.nih.gov\/33270482\/"},{"key":"95336_CR4","doi-asserted-by":"publisher","unstructured":"YOUNOSSI Z M, ALQAHTANI S A, ALSWAT, K. 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