{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:16:27Z","timestamp":1792793787546,"version":"4.5.0"},"reference-count":52,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Epidemiological studies have shown an association between obstructive sleep apnea (OSA) and metabolic dysfunction\u2010associated steatotic liver disease (MASLD), yet the precise role of OSA in MASLD severity remains unclear. We aimed to evaluate the association of OSA with liver histological severity in Chinese bariatric surgery patients, especially metabolic dysfunction\u2010associated steatohepatitis (MASH) and significant fibrosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cross\u2010sectional study enrolled 582 consecutive bariatric surgery patients. Key exclusions were other liver diseases, significant alcohol intake, and prior OSA treatment. All participants underwent preoperative polysomnography and intraoperative liver biopsy. Patients were stratified by biopsy\u2010proven MASLD severity and OSA severity (apnea\u2010hypopnea index, AHI). The primary outcomes were the associations of OSA with histologically defined MASH and significant fibrosis (stage \u22652).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      More severe MASLD subtypes exhibited higher AHI and greater hypoxia (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). OSA severity was positively associated with histological features, including steatosis, ballooning, lobular inflammation, and fibrosis (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), as well as with higher NAFLD activity score (NAS) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and MASH activity grade (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Multivariable analysis identified OSA as an independent predictor associated with histologically confirmed MASLD (odds ratio [OR] 1.86, 95% confidence interval [CI], 1.08\u20133.22), lobular inflammation (OR 95%CI, 1.18\u20132.79), MASH (OR 95%CI, 1.09\u20132.71), and significant fibrosis (OR 95%CI, 1.49\u20137.08). A linear dose\u2013response relationship existed between AHI and both MASH and significant fibrosis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>OSA is associated with more severe histological features of MASLD and contributes to the severity of MASH and significant fibrosis in patients with obesity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70383","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T09:30:47Z","timestamp":1767346247000},"page":"1972-1983","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Obstructive sleep apnea is associated with greater\n                    <scp>MASH<\/scp>\n                    and significant fibrosis severity in patients with obesity: A prospective clinicopathological study"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2331-0522","authenticated-orcid":false,"given":"Jia","family":"Feng","sequence":"first","affiliation":[{"name":"Zhanjiang Central Hospital Guangdong Medical University  Zhanjiang Guangdong China"},{"name":"The First Affiliated Hospital Jinan University  Guangzhou Guangdong China"},{"name":"Institute of Biomedicine, Department of Cellular Biology National Engineering Research Center of Genetic Medicine, Jinan University  Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8206-0733","authenticated-orcid":false,"given":"Wenhui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Bariatric Surgery Center The First Affiliated Hospital of Jinan University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zunhao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pathology The First Affiliated Hospital of Jinan University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuqing","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Bariatric Surgery Center The First Affiliated Hospital of Jinan University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Bariatric Surgery Center The First Affiliated Hospital of Jinan University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhirui","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Bariatric Surgery Center The First Affiliated Hospital of Jinan University  Guangzhou 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