{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:22:53Z","timestamp":1777983773266,"version":"3.51.4"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"crossref","award":["RS-2024-00342613"],"award-info":[{"award-number":["RS-2024-00342613"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"crossref"}]},{"name":"he Korea Health Technology R&D Project through the Korea Health Industry Development Institute","award":["RS-2025-02223073"],"award-info":[{"award-number":["RS-2025-02223073"]}]},{"name":"the Global Learning & Academic Research Institution for Master\u2019s, PhD Students and Postdocs","award":["RS-2025-25440216"],"award-info":[{"award-number":["RS-2025-25440216"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Metabolic dysfunction-associated steatotic liver disease (MASLD) and obstructive sleep apnea (OSA) share overlapping metabolic and inflammatory pathways, yet population-level evidence linking MASLD and incident OSA remains limited. Using a nationwide cohort of 265,452 Korean adults aged\u2009\u2265\u200940 years, we evaluated OSA risk across five mutually exclusive phenotypes defined by steatosis (fatty liver index [FLI]\u2009\u2265\u200930), cardiometabolic risk factors (CMRFs), and alcohol intake: no steatotic liver disease (SLD) without CMRFs, no SLD with CMRFs, MASLD without alcohol, MASLD with alcohol intake below the metabolic-associated alcohol-related liver disease (MetALD) threshold (men\u2009&lt;\u2009210\u00a0g\/week, women\u2009&lt;\u2009140\u00a0g\/week), and MetALD. During a mean follow-up of 9.5 years, 1,025 participants developed OSA. Compared with the reference group, adjusted hazard ratios (aHRs) for OSA were 1.18 (95% confidence intervals [CI] 0.93\u20131.50) in individuals with CMRFs alone, 1.46 (95% CI 1.12\u20131.91) in MASLD without alcohol, 1.52 (95% CI 1.17\u20131.98) in MASLD with alcohol, and 1.40 (95% CI 1.01\u20131.94) in MetALD. Model-based absolute risk differences (ARDs) at 9.5 years showed consistent patterns (+\u20090.05%, +\u20090.14%, +\u20090.16%, and +\u20090.12%, respectively). Sensitivity analyses using stricter steatosis criteria (FLI\u2009\u2265\u200960 or hepatic steatosis index\u2009\u2265\u200936) demonstrated a clearer dose-related gradient, with progressively higher OSA risk across MASLD without alcohol, MASLD with alcohol, and MetALD. These findings highlight MASLD\u2014particularly alcohol-associated phenotypes\u2014as important risk markers for OSA and underscore the need for targeted screening and early intervention strategies in this increasingly prevalent population.<\/jats:p>","DOI":"10.1038\/s41598-026-46037-4","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T04:52:56Z","timestamp":1774846376000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between metabolic dysfunction-associated steatotic liver disease and obstructive sleep apnea: a nationwide retrospective cohort study"],"prefix":"10.1038","volume":"16","author":[{"given":"Chan Ho","family":"Park","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang Yi","family":"Moon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bongjo","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minkook","family":"Son","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"46037_CR1","first-page":"232","volume":"9","author":"M Kazeminia","year":"2023","unstructured":"Kazeminia, M. et al. Global prevalence of obstructive sleep apnea in the elderly and related factors: a systematic review and meta-analysis. Sleep. Health. 9, 232\u2013241 (2023).","journal-title":"Sleep. Health"},{"key":"46037_CR2","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.3390\/diagnostics15091088","volume":"15","author":"G Iannella","year":"2025","unstructured":"Iannella, G. et al. The global burden of obstructive sleep apnea. Diagnostics (Basel). 15, 1088 (2025).","journal-title":"Diagnostics (Basel)"},{"key":"46037_CR3","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1016\/j.jacc.2024.02.059","volume":"84","author":"S Javaheri","year":"2024","unstructured":"Javaheri, S. et al. JACC state-of-the-art review: interactions of obstructive sleep apnea with the pathophysiology of cardiovascular disease. J. Am. Coll. Cardiol. 84, 1208\u20131223 (2024).","journal-title":"J. Am. Coll. Cardiol."},{"key":"46037_CR4","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1530\/EJE-21-1025","volume":"186","author":"HE Koh","year":"2022","unstructured":"Koh, H. E. et al. Effect of obstructive sleep apnea on glucose metabolism. Eur. J. Endocrinol. 186, 457\u2013467 (2022).","journal-title":"Eur. J. Endocrinol."},{"key":"46037_CR5","doi-asserted-by":"publisher","first-page":"1396","DOI":"10.1111\/jdi.13793","volume":"13","author":"C Wang","year":"2022","unstructured":"Wang, C., Tan, J., Miao, Y. & Zhang, Q. Obstructive sleep apnea, prediabetes and progression of type 2 diabetes: a systematic review and meta-analysis. J. Diabetes Investig. 13, 1396\u20131411 (2022).","journal-title":"J. Diabetes Investig"},{"key":"46037_CR6","doi-asserted-by":"publisher","first-page":"2261","DOI":"10.1002\/oby.23679","volume":"31","author":"S Giamp\u00e0","year":"2023","unstructured":"Giamp\u00e0, S. et al. Obstructive sleep apnea and metabolic syndrome: a review of pathophysiology and emerging systemic connections. Obes. (Silver Spring). 31, 2261\u20132270 (2023).","journal-title":"Obes. (Silver Spring)"},{"key":"46037_CR7","doi-asserted-by":"publisher","first-page":"1254459","DOI":"10.3389\/fendo.2023.1254459","volume":"14","author":"H Tang","year":"2023","unstructured":"Tang, H., Lv, F., Zhang, P., Liu, J. & Mao, J. The impact of obstructive sleep apnea on nonalcoholic fatty liver disease. Front. Endocrinol. (Lausanne). 14, 1254459 (2023).","journal-title":"Front. Endocrinol. (Lausanne)"},{"key":"46037_CR8","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1038\/s41366-023-01378-2","volume":"47","author":"M Hany","year":"2023","unstructured":"Hany, M. et al. Effects of obstructive sleep apnea on non-alcoholic fatty liver disease in patients with obesity: a systematic review. Int. J. Obes. (Lond). 47, 1200\u20131213 (2023).","journal-title":"Int. J. Obes. (Lond)"},{"key":"46037_CR9","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1007\/s12072-022-10347-2","volume":"16","author":"Y Fu","year":"2022","unstructured":"Fu, Y. et al. Chronic intermittent hypoxia contributes to non-alcoholic steatohepatitis progression in patients with obesity. Hepatol. Int. 16, 824\u2013834 (2022).","journal-title":"Hepatol. Int."},{"key":"46037_CR10","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/s12026-015-8703-8","volume":"63","author":"D Song","year":"2015","unstructured":"Song, D., Fang, G., Greenberg, H. & Liu, S. F. Chronic intermittent hypoxia exposure-induced atherosclerosis: a brief review. Immunol. Res. 63, 121\u2013130 (2015).","journal-title":"Immunol. Res."},{"key":"46037_CR11","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.jhep.2020.03.039","volume":"73","author":"M Eslam","year":"2020","unstructured":"Eslam, M. et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J. Hepatol. 73, 202\u2013209 (2020).","journal-title":"J. Hepatol."},{"key":"46037_CR12","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1038\/s41575-020-0316-6","volume":"17","author":"H Tilg","year":"2020","unstructured":"Tilg, H. & Effenberger, M. From NAFLD to MAFLD: when pathophysiology succeeds. Nat. Rev. Gastroenterol. Hepatol. 17, 387\u2013388 (2020).","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"46037_CR13","doi-asserted-by":"publisher","first-page":"1966","DOI":"10.1097\/HEP.0000000000000520","volume":"78","author":"ME Rinella","year":"2023","unstructured":"Rinella, M. E. et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 78, 1966\u20131986 (2023).","journal-title":"Hepatology"},{"key":"46037_CR14","doi-asserted-by":"publisher","first-page":"5777","DOI":"10.1038\/s41598-025-89293-6","volume":"15","author":"GE Chung","year":"2025","unstructured":"Chung, G. E. et al. Metabolic dysfunction-associated steatotic liver disease increases cardiovascular disease risk in young adults. Sci. Rep. 15, 5777 (2025).","journal-title":"Sci. Rep."},{"key":"46037_CR15","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.sleep.2022.04.006","volume":"95","author":"Y Ji","year":"2022","unstructured":"Ji, Y., Liang, Y., Mak, J. C. W. & Ip, M. S. M. Obstructive sleep apnea, intermittent hypoxia and non-alcoholic fatty liver disease. Sleep. Med. 95, 16\u201328 (2022).","journal-title":"Sleep. Med."},{"key":"46037_CR16","doi-asserted-by":"publisher","first-page":"49","DOI":"10.2147\/NSS.S398971","volume":"15","author":"J Huang","year":"2023","unstructured":"Huang, J. et al. Association between metabolic-associated fatty liver disease and obstructive sleep apnea: A cross-sectional study. Nat. Sci. Sleep. 15, 49\u201357 (2023).","journal-title":"Nat. Sci. Sleep."},{"key":"46037_CR17","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1007\/s40519-021-01182-9","volume":"27","author":"S Bettini","year":"2022","unstructured":"Bettini, S. et al. Association of obstructive sleep apnea with non-alcoholic fatty liver disease in patients with obesity: an observational study. Eat. Weight Disord. 27, 335\u2013343 (2022).","journal-title":"Eat. Weight Disord."},{"key":"46037_CR18","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.sleep.2017.12.005","volume":"42","author":"E Simou","year":"2018","unstructured":"Simou, E., Britton, J. & Leonardi-Bee, J. Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis. Sleep. Med. 42, 38\u201346 (2018).","journal-title":"Sleep. Med."},{"key":"46037_CR19","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1177\/0194599820931087","volume":"163","author":"C Burgos-Sanchez","year":"2020","unstructured":"Burgos-Sanchez, C. et al. Impact of alcohol consumption on snoring and sleep apnea: A systematic review and meta-analysis. Otolaryngol. Head Neck Surg. 163, 1078\u20131086 (2020).","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"46037_CR20","doi-asserted-by":"crossref","first-page":"16382","DOI":"10.1038\/s41598-023-43129-3","volume":"13","author":"HJ Kim","year":"2023","unstructured":"Kim, H. J. et al. Enhanced alcohol metabolism and sleep quality with continuous positive airway pressure following alcohol consumption. Sci. Rep. 13, 16382 (2023).","journal-title":"Sci. Rep."},{"key":"46037_CR21","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.smrv.2016.07.002","volume":"34","author":"CV Senaratna","year":"2017","unstructured":"Senaratna, C. V. et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep. Med. Rev. 34, 70\u201381 (2017).","journal-title":"Sleep. Med. Rev."},{"key":"46037_CR22","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1093\/aje\/kws342","volume":"177","author":"PE Peppard","year":"2013","unstructured":"Peppard, P. E. et al. Increased prevalence of sleep-disordered breathing in adults. Am. J. Epidemiol. 177, 1006\u20131014 (2013).","journal-title":"Am. J. Epidemiol."},{"key":"46037_CR23","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s12931-020-1284-7","volume":"21","author":"S Andr\u00e9","year":"2020","unstructured":"Andr\u00e9, S. et al. Cardiometabolic comorbidities in obstructive sleep apnea patients are related to disease severity, nocturnal hypoxemia, and decreased sleep quality. Respir. Res. 21, 35 (2020).","journal-title":"Respir. Res."},{"key":"46037_CR24","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1111\/crj.13666","volume":"17","author":"J Gao","year":"2023","unstructured":"Gao, J., Shi, L., Zhu, X. & Liu, J. Association of obstructive sleep apnea with cardiometabolic diseases and cardiovascular mortality. Clin. Respir. J. 17, 764\u2013770 (2023).","journal-title":"Clin. Respir. J."},{"key":"46037_CR25","first-page":"425","volume":"14","author":"S Lavalle","year":"2024","unstructured":"Lavalle, S. et al. Unraveling the complexities of oxidative stress and inflammation biomarkers in obstructive sleep apnea syndrome: A comprehensive review. Life (Basel). 14, 425 (2024).","journal-title":"Life (Basel)"},{"key":"46037_CR26","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1186\/s12974-020-01905-2","volume":"17","author":"X Liu","year":"2020","unstructured":"Liu, X. et al. The relationship between inflammation and neurocognitive dysfunction in obstructive sleep apnea syndrome. J. Neuroinflamm. 17, 229 (2020).","journal-title":"J. Neuroinflamm."},{"key":"46037_CR27","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1038\/s41392-023-01496-3","volume":"8","author":"R Lv","year":"2023","unstructured":"Lv, R. et al. Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome. Signal. Transduct. Target. Ther. 8, 218 (2023).","journal-title":"Signal. Transduct. Target. Ther."},{"key":"46037_CR28","doi-asserted-by":"publisher","first-page":"e37949","DOI":"10.1097\/MD.0000000000037949","volume":"103","author":"ZW Zhao","year":"2024","unstructured":"Zhao, Z. W. et al. Association between sleep apnea and ultrasound-defined liver fibrosis: results from NHANES 2017 to 2020. Med. (Baltim). 103, e37949 (2024).","journal-title":"Med. (Baltim)"},{"key":"46037_CR29","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.ecl.2023.01.006","volume":"52","author":"A Preshy","year":"2023","unstructured":"Preshy, A. & Brown, J. A bidirectional association between obstructive sleep apnea and metabolic-associated fatty liver disease. Endocrinol. Metab. Clin. North. Am. 52, 509\u2013520 (2023).","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"46037_CR30","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1038\/s44324-025-00058-1","volume":"3","author":"F Gachon","year":"2025","unstructured":"Gachon, F. et al. Potential bidirectional communication between the liver and the central circadian clock in MASLD. NPJ Metab. Health Dis. 3, 15 (2025).","journal-title":"NPJ Metab. Health Dis."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-46037-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-46037-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-46037-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T09:44:41Z","timestamp":1774950281000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-46037-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["46037"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-46037-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7423767\/v1","asserted-by":"object"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]},"assertion":[{"value":"21 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"10572"}}