Relationship between metabolic dysfunction-associated steatotic liver disease and sleep disorders: an umbrella review

Umbrella review, also known as a systematic review of systematic reviews, is positioned at the apex of the evidence-based medicine pyramid and represents one of the highest levels of methodology for evidence synthesis. This umbrella review evaluates the current body of evidence linking sleep disorders with metabolic dysfunction-associated steatotic liver disease (MASLD), in light of growing indications that disturbances in sleep may play a role in the development and progression of MASLD. Following PRISMA framework, a systematic literature search was performed across five databases (PubMed, Web of Science, Embase, CNKI, and Wanfang Data) from inception to April 2025. Eligible studies examined the relationship between sleep disorders and MASLD. Twenty studies (seventeen quantitative, three qualitative) were included. Key findings revealed: (1) Short sleep duration and obstructive sleep apnea (OSA) were significantly associated with increased MASLD risk (p < 0.05), prolonged sleep was correlated with a low risk of MASLD; (2) OSA was linked to elevated liver enzyme levels and hepatic fibrosis; (3) No significant association existed between sleep quality and MASLD risk; (4) MASLD patients showed higher prevalence of excessive daytime sleepiness (p < 0.01) and napping habits compared to healthy controls; (5) Prolonged daytime napping predicted unfavorable MASLD outcomes. Sleep disorders, particularly short sleep duration and OSA, have been identified as risk factors for MASLD outcomes. While underlying mechanisms remain underexplored, future clinical studies are warranted to elucidate the specific mechanisms underlying the effects of sleep disturbances on MASLD pathogenesis.

The online version contains supplementary material available at 10.1007/s41105-026-00636-w.