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Purpose <p>To explore the association of sleep modes with metabolic dysfunction-associated steatotic liver disease (MASLD) in type 2 diabetes mellitus (T2DM).</p> Methods <p>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).</p> Results <p>Over an average follow-up of 3.23&#xa0;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:&#xa0;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&#xa0;min can increase the MASLD risk (HR = 1.82, 95% CI:&#xa0;1.30–2.53, in GNSP-LN; HR = 1.40, 95% CI:&#xa0;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.</p> Conclusions <p>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.</p>

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Combined nocturnal sleep pattern and napping duration in relation to metabolic dysfunction-associated steatotic liver disease risk and prediction in type 2 diabetes mellitus

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月22日

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  • Meng Zhu,
  • Liang Yao,
  • Lijuan Yang,
  • Siyu Gao,
  • Penghua Shi,
  • Hong Chen,
  • Tao Hong,
  • Hailing Wang,
  • Yuhua Wang,
  • Xiang Hu,
  • Qidong Zheng,
  • Xuejiang Gu

摘要

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.