Abstract
Obstructive sleep apnea (OSA) may be associated with the pathogenesis and severity of metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to determine the relationship between OSA and MASLD in type 2 diabetes mellitus (T2DM) patients. OSA was diagnosed via polysomnography, and liver ultrasound was used to measure the severity of MASLD in hospitalized patients with T2DM. The severity of OSA was categorized as non, mild, moderate, and severe according to the apnea-hypopnea index (AHI). Moreover, the oxygen desaturation index (ODI) and the lowest oxygen saturation (LSaO2) during sleep were recorded. Classification and analysis were conducted according to the level and severity of ODI and LSaO2. Age, sex, duration of diabetes, and history of smoking and drinking were recorded. Height and weight were measured, and BMI was calculated. Plasma glucose and serum lipid levels were assessed. Among the participants, 64.4% had both MASLD and OSA, 47.5% had moderate-to-severe MASLD, and 43.4% had moderate-to-severe OSA. In addition, 100% of severe MASLD patients had OSA, with 50% demonstrating moderate (8.3%) or severe (41.7%) OSA. A total of 91.5% of moderate-to-severe OSA patients had moderate-to-severe MASLD. A total of 62.5%, 58.5%, and 57.2% of moderate or severe MASLD patients had moderate or severe AHI, LSaO2, and ODI, respectively. AHI, LSaO2, and ODI were more serious in patients with moderate-to-severe MASLD than in those with non-to-mild MASLD. OSA was closely associated with the occurrence of moderate-to-severe MASLD after adjusting for age, sex, duration of diabetes, BMI, and blood lipid and blood glucose levels. In T2DM patients, the prevalence of OSA and MASLD is high, and the prevalence of MASLD is greater in moderate-to-severe OSA patients. The severity of MASLD was positively correlated with AHI, LSaO2, and ODI findings. OSA may aggravate the severity of MASLD, excluding other influencing factors, and vice versa, those with MASLD for OSA. Clinicians should screen OSA patients for the presence and severity of MASLD and vice versa.