Sleep apnea may worsen fatty liver disease, now called metabolic dysfunction-associated steatotic liver disease (MASLD), by lowering oxygen levels at night. This can trigger chronic inflammation and cause fat to build up in the liver.

Sleep apnea and fatty liver disease often occur together and share many similar risk factors. Sleep apnea, especially obstructive sleep apnea (OSA), causes repeated pauses in breathing during sleep.

Fatty liver disease, now called metabolic dysfunction-associated steatotic liver disease (MASLD), leads to fat buildup in the liver. Both conditions are closely linked to obesity, insulin resistance, and chronic inflammation.

​​Sleep apnea and MASLD are closely linked, and one condition can worsen the other. According to a 2023 study, here’s how they’re connected:

  • Chronic intermittent hypoxia: Chronic intermittent hypoxia is varying periods of low oxygen levels in your blood. One cause, OSA, is a repeated drop in oxygen levels during sleep. This can inflame the liver, increase fat buildup, and lead to liver scarring (fibrosis).
  • Systemic inflammation: Both conditions trigger continuous inflammation in the body, which can affect liver function and make it harder to manage blood sugar and break down fat.
  • Metabolic dysfunction: Obesity, insulin resistance, and high blood sugar often affect people with both conditions. These factors affect how the body stores fat, putting strain on the liver and breathing.
  • Oxidative stress: Oxidative stress is a condition that leads to cell damage. Low oxygen at night produces unstable molecules called free radicals. These can damage liver cells and increase inflammation, worsening MASLD over time.

Research from 2024 also suggests that people with severe obstructive sleep apnea have a higher risk of developing advanced MASLD, including liver fibrosis.

Yes, if you have MASLD, you should consider being screened for sleep apnea, especially if you have other risk factors.

You may be at higher risk if you:

If you have MASLD and notice any signs of sleep apnea, consider talking with a healthcare professional. A sleep study (polysomnography) may help confirm the diagnosis.

Treating sleep apnea and fatty liver disease often involves a combination of lifestyle changes, medical treatment, and regular follow-up.

Here are some treatment options to consider:

  • CPAP therapy: Using a continuous positive airway pressure (CPAP) machine can help keep your airway open at night and improve sleep quality. Some research also suggests it may help improve liver enzyme levels in people with MASLD.
  • Exercise and diet: Regular physical activity and a Mediterranean diet can help lower liver fat and improve how your body uses insulin. These changes may also help you sleep better and reduce the severity of sleep apnea.
  • Weight loss: Losing even 5% to 10% of your body weight can help lower liver fat, reduce inflammation, and make breathing easier during sleep, especially if you have obesity.
  • Bariatric surgery: If you have severe obesity, your doctor may recommend weight loss surgery. Bariatric surgery has been shown to improve sleep apnea and MASLD in some people.
  • Managing underlying health conditions: Treating high blood sugar, cholesterol, and blood pressure can improve metabolic health and help keep both conditions under control.

While sleep apnea often causes noticeable symptoms during sleep or daily life, MASLD can progress quietly without obvious symptoms.

Commonly reported symptoms of sleep apnea include:

Other possible symptoms include dry mouth upon waking, waking up frequently at night, and irritability or changes in mood.

MASLD symptoms are often absent in the early stages. However, when symptoms occur, they may include:

Many people with MASLD don’t experience noticeable symptoms until the disease has progressed, leading to complications such as liver fibrosis or cirrhosis.

The outlook depends on early diagnosis, lifestyle changes, and proper management of both conditions.

Without treatment, sleep apnea and MASLD can worsen and lead to serious health problems, including:

  • Heart disease: Chronic inflammation and stress from untreated sleep apnea and MASLD can increase the risk of heart disease.
  • Type 2 diabetes: Both conditions are linked to insulin resistance, which can lead to diabetes.
  • Liver damage: MASLD can progress to more serious liver conditions, including nonalcoholic steatohepatitis (NASH), cirrhosis, or even liver failure.
  • Daytime fatigue and cognitive impairment: Poor sleep from untreated sleep apnea can lead to excessive fatigue and difficulty concentrating.

However, early diagnosis and proper treatment, such as using CPAP, making lifestyle changes, and regular follow-up, can help prevent complications and improve quality of life.

Sleep apnea can lead to low oxygen (hypoxia) levels at night, which may cause liver inflammation, increase fat buildup, and lead to liver scarring.

Yes, research from 2024 suggests that people with fatty liver disease, especially those with obesity or insulin resistance, are more likely to develop obstructive sleep apnea.

Excess body fat, especially around your abdomen, can press on your airway and make it harder for your body to process fat, increasing the risk of developing sleep apnea and fatty liver disease.

Sleep apnea and fatty liver disease are closely connected and often occur together. Shared risk factors like obesity and insulin resistance make it important to screen for both.

Early treatment, including weight loss, CPAP therapy, and lifestyle changes, can help manage symptoms and prevent complications.

If you think you might have one or both conditions, talk with a healthcare professional to get the right diagnosis and treatment plan.