Does Continuous Positive Airway Pressure Improve Liver Outcomes in MASLD with Obstructive Sleep Apnea? A Systematic...

Area of Science:

• Hepatology
• Sleep Medicine
• Metabolic Disorders

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) frequently co-occurs with obstructive sleep apnea (OSA).
• Overlapping metabolic risk factors contribute to the high comorbidity of MASLD and OSA.
• The impact of continuous positive airway pressure (CPAP) on hepatic outcomes in MASLD patients with OSA is not well-established.

Purpose of the Study:

• To systematically review the effects of OSA treatment on liver and metabolic outcomes in patients with MASLD.
• To evaluate the efficacy of CPAP and other interventions in managing MASLD and associated metabolic parameters.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) and observational studies.
• Searched PubMed, Web of Science, and CINAHL for studies on adults with MASLD and OSA.
• Assessed liver stiffness, fat content, enzymes, fibrosis, HbA1c, lipids, anthropometrics, and risk of bias.

Main Results:

• Eight studies (3 RCTs, 5 observational) involving 1006 participants were included.
• CPAP showed modest, inconsistent reductions in liver enzymes (ALT, AST) and small improvements in HbA1c and triglycerides.
• No significant improvements were observed in liver stiffness, steatosis, fibrosis, or body composition across studies.

Conclusions:

• CPAP may offer marginal benefits for liver enzymes and certain metabolic markers in MASLD patients with OSA.
• Evidence supporting CPAP's efficacy in improving liver steatosis, fibrosis, or body composition is limited.
• Low certainty of evidence necessitates high-quality, longitudinal trials to clarify CPAP's role in MASLD management.