Study Suggests Fragmented Nocturnal Sleep May Play a Role in MASLD Development

Sofia Schaeffer

Credit: ResearchGate

A recent study revealed patients with metabolic dysfunction-associated steatotic liver disease (MASLD) have significant fragmented nocturnal sleep due to their frequent awakenings per night.¹ The findings suggest fragmented nocturnal sleep may play a pathophysiological role in the development of MASLD.

“Whether MASLD [causes] sleep disorders or vice versa remains unknown,” said lead investigator Sofia Schaeffer, a postdoctoral researcher at the University of Basel and Basel’s University Center for Gastrointestinal and Liver Diseases, in a press release.²

MASLD has a multifactorial pathogenesis involving dietary, environmental, and genetic factors, and, according to mouse models, circadian misalignment.¹ Circadian misalignment may influence MASLD development since it affects the metabolism in several organs, including the liver. Sleep questionnaires also showed that patients with MASLD have sleep-wake disruption.

Investigators aimed to assess the sleep-wake rhythms in patients with MASLD (n = 35) and healthy controls (n = 16) using 24/7 actigraphy for 4 weeks. After 2 weeks, patients received a single standardized sleep hygiene education session on practical measures to improve sleep habits, and the team hoped this would realign sleep rhythms.

The team recruited patients with MASLD, MASH, or MASH with cirrhosis between 2019 and 2021 from the University Centre for Gastrointestinal and Liver Diseases in Switzerland. They also recruited healthy controls, who either had non-MASH-related liver cirrhosis or were age-matched healthy volunteers. Participants with MASLD were obese (median BMI = 31 kg/m2) and had significantly greater levels of triglycerides, fasting glucose, and insulin in their blood than healthy controls—but lower total cholesterol levels. Also, 80% of patients with MASLD had metabolic syndrome.

Participants wore an actigraph wristband, the ActTrust device, which tracked light, physical activity, and body temperature. With the device, the team could measure the following: bedtime, get-up time, time in bed, total sleep time, sleep onset latency, sleep efficiency, number of awakenings, wakefulness after sleep onset number, total time, and percentage of main and secondary sleep episodes.

Patients visited the clinic at the start, midpoint, and end of the 4-week follow-up and filled out a sleep questionnaire at the beginning and end of the trial.

The actigraphy data showed that patients with MASLD had more awakenings per night (8.5 vs 5.5; P = .0036), longer wakefulness after sleep onset (45.4 minutes vs 21.3 minutes; P = .0004), and decreased sleep efficacy (86.5% vs 92.8%; P = .0008) compared with healthy controls. Despite patients with MASLD having poorer sleep than controls, both cohorts had a comparable sleep duration.

However, patients with MASLD self-reported a shorter sleep duration than controls (6 hours vs 6 hours and 45 minutes; P = .01). Patients with MASLD also reported a prolonged sleep latency which contributed to poorer sleep quality. Moreover, in their sleep diaries, 32% of patients with MASLD reported experiencing sleep disturbances caused by psychological stress, compared with only 6% of healthy controls.

Standardized sleep hygiene education did not improve sleep parameters. Investigator Christine Bernsmeier, a professor at the University of Basel, said in the press release that future studies should explore perpetual sleep counseling sessions or interventions such as light therapy alongside lifestyle changes to improve sleep-wake patterns in patients with MASLD.²

“Here we show for the first time with an objective method, 24/7 actigraphy, that the sleep-wake rhythm in patients with MASLD does indeed differ from that in healthy individuals: those with MASLD demonstrated significant fragmentation of their nightly sleep due to frequent awakenings and increased wakefulness,” Shaeffer said.

References

1. ^{Significant nocturnal wakefulness after sleep onset in metabolic dysfunction–associated steatotic liver disease. Frontier in Network. Physiology. 2024. https://doi.org/10.3389/fnetp.2024.1458665}
2. ^{Broken sleep a hallmark sign of living with the most common liver disease, scientists find. EurekAlert! December 4, 2024. https://www.eurekalert.org/news-releases/1066657. Accessed December 5, 2024.}