One of the new studies found that frequent nighttime awakening was associated with faster disease progression in MASLD (metabolic dysfunction-associated steatotic liver disease) patients. So better sleep in these patients may also help slow the disease down.
Metabolic health issues are now everywhere. Some major risk factors for metabolic disease are too many calories, sitting too much, stress, and poor sleep. Many people know they need to change their diet or exercise. But they are not doing enough to cut chronic stress and sleep better.
Many people also do not know about some metabolic disorders. Most people know about diabetes. Very few know that fatty liver disease is much more common than diabetes or even heart disease.
In fact, studies show that more than 30% of adults in the US live with fatty liver disease. It used to be called non-alcoholic fatty liver disease (NAFLD). Now it is called MASLD (metabolic dysfunction-associated steatotic liver disease).
Worse, even science does not fully understand MASLD. We know it mostly affects obese people. We know it is caused by too much fat building up in the liver. But science still does not know why this fat buildup is worse in some obese people and milder in others.
MASLD gets worse slowly over the years. It causes few symptoms in its early stages. That is one reason so few people know about it. But like any other metabolic disorder, it causes many problems if left untreated.
MASLD significantly raises the risk of diabetes. It is among the leading causes of liver cancer. It may also raise the risk of kidney disease. People with it also face a greater risk of heart attack and stroke. In older adults, MASLD causes fatigue and greater muscle loss.
Earlier studies showed that sleep problems are common in people with MASLD. Now a new study shows the link runs both ways. Sleep problems also raise the risk of MASLD. And MASLD gets worse faster in people with sleep problems.
For good health, you need 7-8 hours of sleep. But you also need good sleep with few awakenings. This new study found that people who wake often and sleep poorly are more likely to see MASLD get worse faster.
In the study, researchers enrolled 46 men and women diagnosed with MASLD between 2019 and 2021. Patients were tested on a regular basis. They also filled out sleep surveys about their sleep habits. Researchers asked them to keep sleep diaries too. All the patients were obese, and 80% of them had metabolic syndrome.
Besides surveys and diaries, the researchers used an actigraph. This is a device that tracks sleep remotely. It made sure their findings were objective.
The actigraph data showed little difference in how long patients slept. All patients spent about the same amount of time in bed.
But a closer look at the sleep data told a different story. Those whose MASLD had progressed further were 55% more likely to wake during the night. Their awake periods at night were also longer than in healthy adults (almost double).
In the sleep diaries, 32% of MASLD patients reported stress and trouble sleeping. Just 6% of healthy adults did.
So researchers think we need to focus on better sleep for people with MASLD. They also noticed that short-term sleep fixes in MASLD do not seem to work. That is why they think larger clinical studies with broader methods are needed to improve sleep in these patients. Future studies must look at how sleep treatments affect MASLD progression.
Frequently asked questions
Can poor sleep make fatty liver disease worse?
Yes. A study looked at 46 adults with MASLD. Those whose disease progressed further were 55% more likely to wake during the night. Their awake periods lasted almost twice as long as in healthy adults. Time in bed was about the same for everyone. So the problem was broken sleep, not short sleep.
Can lack of sleep cause liver problems?
Poor sleep is a major risk factor for metabolic disease, along with excess calories, inactivity and stress. The link with fatty liver runs both ways. MASLD disrupts sleep. And sleep problems raise the risk of MASLD and speed up its progression. That makes good sleep, with few awakenings, a real lever, not an afterthought.
What is MASLD?
MASLD stands for metabolic dysfunction-associated steatotic liver disease. It is the new name for non-alcoholic fatty liver disease (NAFLD). It is too much fat built up in the liver, and it mostly affects people with obesity. More than 30% of adults in the US live with it. That makes it more common than diabetes or even heart disease.
Is fatty liver disease serious?
Yes. MASLD gets worse slowly and causes few symptoms early. So many people do not know they have it. Left untreated, it raises the risk of diabetes, kidney disease, heart attack and stroke. It is among the leading causes of liver cancer. It also causes fatigue and greater muscle loss in older adults.
Source:
Schaeffer, S., Bogdanovic, A., Hildebrandt, T., Flint, E., Geng, A., Pecenko, S., Lussier, P., Strumberger, M. A., Meyer, M., Weber, J., Heim, M. H., Cajochen, C., & Bernsmeier, C. (2024). Significant nocturnal wakefulness after sleep onset in metabolic dysfunction–associated steatotic liver disease. Frontiers in Network Physiology, 4. https://doi.org/10.3389/fnetp.2024.1458665
Dr. Gurpreet Singh Padda, MD, MBA, MHP
