Diabetology & metabolic syndrome · 2026
Combined nocturnal sleep pattern and napping duration in relation to metabolic dysfunction-associated steatotic liver disease risk and prediction in type 2 diabetes mellitus.
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Zhu Meng, Yao Liang, Yang Lijuan, Gao Siyu, Shi Penghua, Chen Hong, Hong Tao, Wang Hailing, Wang Yuhua, Hu Xiang, Zheng Qidong, Gu Xuejiang
Аннотация
PURPOSE: To explore the association of sleep modes with metabolic dysfunction-associated steatotic liver disease (MASLD) in type 2 diabetes mellitus (T2DM).
METHODS: A total of 1900 patients with T2DM were enrolled between March 2017 and December 2024. Sleep behaviors were collected via questionnaires. Four sleep modes were defined by combining nocturnal sleep factors and nap: good nocturnal sleep pattern with short/long nap (GNSP-SN/LN) and poor nocturnal sleep pattern with short/long nap (PNSP-SN/LN). Cox regression analysis was used to examine the association between sleep and MASLD. Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) quantified the added value of sleep modes to the Fatty Liver Index (FLI).
RESULTS: Over an average follow-up of 3.23 years, 379 new-onset MASLD events were identified based on ultrasound criteria in this retrospective cohort study. Four nocturnal sleep factors and napping duration were positively related to the MASLD in T2DM patients (HR for adverse sleep behaviors ranged from 1.64 to 2.26). Compared to GNSP-SN, GNSP-LN (HR = 1.88, 95% CI: 1.37-2.61), PNSP-SN (HR = 2.54, 95% CI: 1.91-3.37), and PNSP-LN (HR = 3.51, 95% CI: 2.53-4.87) were associated with higher MASLD risk. Napping more than 30 min can increase the MASLD risk (HR = 1.82, 95% CI: 1.30-2.53, in GNSP-LN; HR = 1.40, 95% CI: 1.01-1.93, in PNSP-LN). Incorporating sleep modes into the FLI improved prediction, with an NRI of 0.21 and an IDI of 0.06.
CONCLUSIONS: Poor nocturnal sleep was independently associated with a substantially higher risk of MASLD. Prolonged napping might increase the MASLD risk, regardless of the pattern of nocturnal sleep. Combining sleep modes with FLI provides exploratory evidence of improved discrimination for incident MASLD.
METHODS: A total of 1900 patients with T2DM were enrolled between March 2017 and December 2024. Sleep behaviors were collected via questionnaires. Four sleep modes were defined by combining nocturnal sleep factors and nap: good nocturnal sleep pattern with short/long nap (GNSP-SN/LN) and poor nocturnal sleep pattern with short/long nap (PNSP-SN/LN). Cox regression analysis was used to examine the association between sleep and MASLD. Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) quantified the added value of sleep modes to the Fatty Liver Index (FLI).
RESULTS: Over an average follow-up of 3.23 years, 379 new-onset MASLD events were identified based on ultrasound criteria in this retrospective cohort study. Four nocturnal sleep factors and napping duration were positively related to the MASLD in T2DM patients (HR for adverse sleep behaviors ranged from 1.64 to 2.26). Compared to GNSP-SN, GNSP-LN (HR = 1.88, 95% CI: 1.37-2.61), PNSP-SN (HR = 2.54, 95% CI: 1.91-3.37), and PNSP-LN (HR = 3.51, 95% CI: 2.53-4.87) were associated with higher MASLD risk. Napping more than 30 min can increase the MASLD risk (HR = 1.82, 95% CI: 1.30-2.53, in GNSP-LN; HR = 1.40, 95% CI: 1.01-1.93, in PNSP-LN). Incorporating sleep modes into the FLI improved prediction, with an NRI of 0.21 and an IDI of 0.06.
CONCLUSIONS: Poor nocturnal sleep was independently associated with a substantially higher risk of MASLD. Prolonged napping might increase the MASLD risk, regardless of the pattern of nocturnal sleep. Combining sleep modes with FLI provides exploratory evidence of improved discrimination for incident MASLD.