Healthy sleep patterns and risk of incident cardiovascular disease, liver-related events, and all-cause mortality among individuals with metabolic dysfunction--associated steatotic liver disease: A large prospective cohort study.

Objectives: This study aimed to investigate the association between overall healthy sleep patterns and cardiovascular disease, liver-related events, and all-cause mortality among individuals with metabolic dysfunction--associated steatotic liver disease.

Methods: This cohort study included 123,228 participants with metabolic dysfunction--associated steatotic liver disease from the UK Biobank, who had detailed sleep assessment at baseline. The healthy sleep pattern was constructed by a composite healthy sleep score that incorporated different sleep behaviors. Incident cardiovascular disease, liver-related events, and all-cause mortality were identified from hospital inpatient records and death register systems. Cox proportional hazards models and restricted cubic splines were applied to estimate hazard ratios and 95% confidence intervals (CIs).

Results: During a 15.45 person-years of follow-up, we recorded 20,287 cardiovascular disease events, 1304 liver-related events, and 10,306 deaths in patients with metabolic dysfunction--associated steatotic liver disease. Compared with participants with a poor sleep pattern, the multivariable-adjusted hazard ratios for participants with a healthy sleep pattern were 0.72 (95% CI, 0.67-0.77) for cardiovascular disease, 0.73 (95% CI, 0.57-0.94) for liver-related events, and 0.87 (95% CI, 0.79-0.96) for all-cause mortality. Restricted cubic splines indicated a significant linear association between healthy sleep scores and cardiovascular disease, liver-related events, and all-cause mortality in patients with metabolic dysfunction--associated steatotic liver disease.

Conclusions: Our findings suggest that patients with metabolic dysfunction--associated steatotic liver disease who maintained healthy sleep patterns were associated with a lower risk of cardiovascular disease, liver-related events, and mortality, highlighting the importance of favorable sleep patterns in the prevention of intrahepatic/extrahepatic events in individuals with metabolic dysfunction--associated steatotic liver disease.