Longitudinal Impact of Sleep Duration on Liver Stiffness Velocity in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Five-Year Prospective Cohort Study

Background:
The clinical shift from non-alcoholic fatty liver disease (NAFLD) to
metabolic dysfunction-associated steatotic liver disease (MASLD)
emphasizes identifying modifiable drivers of fibrotic progression. While
obesity and diabetes are established risk factors, the independent impact
of sleep duration on the “velocity” of liver stiffness measurement
(LSM)-the longitudinal rate of change-remains poorly characterized.
Objective:
This study aimed to quantify the 5-year relationship between sleep
duration and liver stiffness velocity.
Methods:
We conducted a prospective cohort study of 1,076 participants in
Bangladesh (Dhaka, Rangpur, Sylhet) from 2020 to 2025. Baseline and
5-year liver stiffness were measured using vibration-controlled transient
elastography (VCTE). Sleep duration was assessed via the Pittsburgh
Sleep Quality Index (PSQI). Multivariable regression and causal
mediation analysis evaluated the impact of sleep on LSM change (∆
LSM).
Results:
Over 5 years, 19.7% of individuals were Progressors. Multivariable
regression established sleep duration as a potent independent predictor
of liver stiffness velocity (β=-0.20,95% CI: -0.28, -0.12, p<0.001), while
BMI was not a significant longitudinal driver in adjusted models.
Mediation analysis confirmed a significant direct effect of sleep on ∆
LSM (ADE=-0.19, p<0.001), with negligible mediation by BMI. Survival
analysis showed that individuals sleeping ≤6 hours had a significantly
higher hazard for reaching advanced fibrosis compared to those
sleeping ≥6 hours.
Conclusion:
Short sleep duration is a direct, primary driver of liver stiffness velocity
in MASLD. Restorative sleep (≥7 hours) is associated with stability and
is a prerequisite for fibrosis regression. Addressing sleep hygiene is a
critical, independent therapeutic target for preventing advanced liver
disease.