According to scientists, disturbed sleep is a typical sign that you are living with the most common liver disease

The prevalence of MASLD (metabolic dysfunction-associated steatotic liver disease) is increasing explosively in most regions of the world, compounded by increasing obesity and a sedentary lifestyle. MASLD (formerly known as non-alcoholic fatty liver disease) is already the most common liver disease: it affects 30% of adults and between 7% and 14% of children and adolescents, and this prevalence is expected to increase to over 55%. of adults by 2040.

People with MASLD have an increased risk of diabetes, hepatocellular carcinoma, non-liver-related cancers, chronic kidney disease, age-related muscle loss, and cardiovascular disease.

Previous studies have linked disruptions in the circadian clock and sleep cycle to the development of MASLD. However, the American Academy of Sleep Medicine has recommended using objective measurements – rather than subjective ones like sleep questionnaires – to prove this hypothesized link between sleep disorders and the circadian rhythm, MASLD and MASH.

MASH is a more severe form of MASLD in which the liver is damaged by inflammation and tissue scarring caused by an abnormal accumulation of fat.

“Here we show for the first time, using an objective method, 24/7 actigraphy, that the sleep-wake rhythm in patients with MASLD actually differs from that in healthy individuals: patients with MASLD showed significant fragmentation of their nocturnal sleep more frequent awakenings and increased alertness,” said Dr. Sofia Schaeffer, postdoctoral researcher at the University of Basel and the University Center for Gastrointestinal and Liver Diseases Basel and corresponding author of a new study in Limits of network physiology.

Actigraphy tracks gross motor activity using a wrist-worn sensor.

Don’t lose sleep

Between 2019 and 2021, Schaeffer and colleagues recruited 46 adult women and men diagnosed with either MASLD, MASH, or MASH with cirrhosis. An additional eight patients with non-MASH-related liver cirrhosis served as a comparison group, while a second comparison group consisted of 16 age-matched healthy volunteers. Each study participant was equipped with an actigraph that could be worn at any time and recorded light, physical activity and body temperature.

Participants attended the clinic as outpatients at the beginning, middle, and end of the four-week follow-up. At both the beginning and end of this period, they underwent a clinical examination and were asked about their sleeping habits using sleep questionnaires. They also kept a sleep diary.

All patients with MASLD were obese and 80% had metabolic syndrome. Patients with MASLD also had significantly higher levels of triglycerides, fasting glucose and insulin in their blood than healthy participants, but lower levels of total cholesterol, “bad” LDL cholesterol and “good” HDL cholesterol.

Rude awakening

Actigraph measurements found no differences between patients with MASLD and healthy participants when it came to things like sleep duration or time spent in bed.

Importantly, the actigraphy showed that compared to healthy volunteers, patients with MASLD woke up 55% more often at night and stayed awake 113% longer after first falling asleep. Patients with MASLD also slept more frequently and longer during the day. Sleep patterns and quality, as measured by actigraph, were similarly impaired in patients with MASH, MASH with cirrhosis, and non-MASH-related cirrhosis.

Subjectively, patients with MASLD self-reported their disrupted and inefficient sleep as shorter sleep with delayed onset. In their sleep diaries, 32% of patients with MASLD reported sleep disturbances caused by psychological stress, compared to only 6% of healthy participants.

“We concluded from our data that sleep fragmentation plays a role in the pathogenesis of MASLD in humans. Whether MASLD causes sleep disorders or vice versa remains unknown,” Schaeffer said.

“The underlying mechanism is probably due to genetic factors, environmental factors and the activation of immune responses – ultimately caused by obesity and metabolic syndrome.”

Schaeffer and colleagues also attempted to improve participants’ sleep with a single sleep hygiene training session conducted midway through the study. Here they were given practical measures to improve their sleeping habits. However, the results showed that the session did not improve actigraphy or self-reported measures of sleep quality and quantity.

“A single training course on sleep hygiene was not enough to have a lasting impact on circadian rhythms in either patients with MASLD or healthy controls. Future studies should examine ongoing sleep counseling sessions or interventions such as light therapy in combination with other lifestyle changes to improve sleep hygiene. “Sleep-wake cycle in patients with MASLD,” recommends Christine Bernsmeier, professor at the University of Basel and senior author of the study .