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Updated: Jan 7, 2026

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
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Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea

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Obstructive sleep apnea is associated with greater MASH and significant fibrosis severity in patients with obesity: A

Jia Feng1,2,3, Wenhui Chen4, Zunhao Zhang5

  • 1Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, Guangdong, China.

Diabetes, Obesity & Metabolism
|January 2, 2026
PubMed
Abstract

Insights

Obstructive sleep apnea (OSA) is linked to more severe metabolic dysfunction-associated steatotic liver disease (MASLD) and its complications, including metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis, in bariatric surgery patients.

Area of Science:

  • Hepatology
  • Sleep Medicine
  • Bariatric Surgery

Background:

  • Epidemiological studies suggest a link between obstructive sleep apnea (OSA) and metabolic dysfunction-associated steatotic liver disease (MASLD).
  • The exact impact of OSA on MASLD histological severity, particularly metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis, requires further elucidation.

Purpose of the Study:

  • To investigate the association between OSA severity and liver histological findings in Chinese patients undergoing bariatric surgery.
  • To determine if OSA is an independent predictor of MASH and significant liver fibrosis in this population.

Main Methods:

  • A prospective cross-sectional study included 582 bariatric surgery patients.
  • Participants underwent polysomnography and liver biopsy; exclusions included other liver diseases, heavy alcohol use, and prior OSA treatment.
  • Patients were stratified by MASLD and OSA severity (apnea-hypopnea index, AHI); primary outcomes were MASH and significant fibrosis (stage ≥2).

Main Results:

  • More severe MASLD correlated with higher AHI and increased hypoxia.
  • OSA severity showed positive associations with steatosis, ballooning, lobular inflammation, fibrosis, NAFLD activity score (NAS), and MASH activity grade.
  • Multivariable analysis confirmed OSA as an independent predictor for MASLD, lobular inflammation, MASH, and significant fibrosis, with a dose-response relationship between AHI and MASH/fibrosis severity.

Conclusions:

  • Obstructive sleep apnea is significantly associated with more severe histological features of MASLD.
  • OSA independently contributes to the progression of MASH and significant fibrosis in obese patients undergoing bariatric surgery.
Keywords:
fibrosismetabolic dysfunction‐associated steatohepatitismetabolic dysfunction‐associated steatotic liver diseaseobesityobstructive sleep apnea

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