MASLD (formerly known as non-alcoholic fatty liver disease) is the most common liver disorder: it affects 30 per cent of adults and between 7 per cent and 14 per cent of children and adolescents. This prevalence is predicted to rise to more than 55 per cent of adults by 2040. While previous studies have implicated disturbances in the circadian clock and the sleep cycle in the development of MASLD, the new study by researchers from the University of Basel in Switzerland showed for the first time that the sleep-wake rhythm in patients with MASLD does indeed differ from that in healthy individuals.
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In the paper, published in the journal Frontiers in Network Physiology, the team showed that patients with MASLD woke 55 per cent more often at night, and lay 113 per cent longer awake after having first fallen asleep, compared to healthy volunteers. Patients with MASLD also slept more often and longer during the day. "People with MASLD have significant fragmentation of their nightly sleep due to frequent awakenings and increased wakefulness," said Dr Sofia Schaeffer, a postdoctoral researcher at the University of Basel.
The team recruited 46 adult women and men diagnosed with either MASLD, or MASH, or MASH with cirrhosis; compared them with eight patients who had non-MASH-related liver cirrhosis. These were also compared with 16 age-matched healthy volunteers. Each study participant was equipped with an actigraph -- to track gross motor activity with a sensor worn on the wrist -- to be worn at all times, which tracked light, physical activity, and body temperature.
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The results showed that sleep patterns and quality as measured by the actigraph were similarly impaired in patients with MASH, MASH with cirrhosis and non-MASH-related cirrhosis. Further, 32 per cent of patients with MASLD reported experiencing sleep disturbances caused by psychological stress, compared to only 6 per cent of healthy participants. The findings showed that "sleep fragmentation plays a role in the pathogenesis of human MASLD," said Schaeffer. While it remains unknown whether MASLD causes sleep disorders or vice versa, the underlying mechanism likely involves "genetics, environmental factors, and the activation of immune responses -- ultimately driven by obesity and metabolic syndrome."
