Obstructive sleep apnea is associated with greater MASH and significant fibrosis severity in patients with obesity: A prospective clinicopathological study
Authors' conclusion
OSA is associated with more severe histological features of MASLD and contributes to the severity of MASH and significant fibrosis in patients with obesity.
Study context
- Population
- Chinese bariatric surgery patients with obesity, without other liver diseases, significant alcohol intake or prior obstructive sleep apnea (OSA) treatment; preoperative polysomnography and intraoperative liver biopsyconsecutive
- Participants
- 582 patients
- Exposure
- OSA vs no OSA
- Outcome
- Associations of OSA with histologically defined MASH and significant fibrosis (stage ≥2)
Methodological detailsconsecutive enrolment, clinicopathological
- Consecutive enrolment
- Clinicopathological
Main finding
As reported in the abstract
- OSA independent predictor of MASH, OR 95%CI
- 1.09-2.71
- OSA independent predictor of significant fibrosis, OR 95%CI
- 1.49-7.08
- Linear dose-response between AHI and both MASH and significant fibrosis
- p < 0.05
Observational data: associations, not effects.
Further findings
Histologically confirmed MASLD (multivariable analysis)
| OR (95% CI) | ||
|---|---|---|
| OSA | 1.86 (1.08–3.22) | |
| 0.20.5125Odds ratio (log scale) |
Lobular inflammation (multivariable analysis)
- OSA independent predictor, OR 95%CI
- 1.18-2.79
AHI and hypoxia across MASLD subtypes
- More severe MASLD subtypes had higher AHI and greater hypoxia
- P < 0.05
OSA severity and histological features
- Positive association with steatosis, ballooning, lobular inflammation and fibrosis
- all p < 0.05
- Positive association with higher NAFLD activity score (NAS)
- P < 0.001
- Positive association with MASH activity grade
- P < 0.001
Original publication
Obstructive sleep apnea is associated with greater MASH and significant fibrosis severity in patients with obesity: A prospective clinicopathological study. Diabetes Obes Metab. Published 2 January 2026. doi:10.
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