Abstract
Objective
Reduced sleep quality in children has been associated with obesity and fatty liver disease. However, there are no studies evaluating the impact of gastrointestinal symptoms on sleep quality in children with metabolic dysfunction-associated steatotic liver disease (MASLD). The aim of this cross-sectional study was to investigate the prevalence of gastrointestinal symptoms and sleep disturbances in children with MASLD and to examine the association of gastrointestinal symptoms with sleep disturbances.
Methods
Anthropometric and biochemical examinations were performed on children aged 8-18 years, including children with MASLD and matched healthy controls for comparison. The Hepatic Steatosis Index (HSI) and Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS) were calculated for children with MASLD. Sleep disturbances were assessed using the Child Sleep Habits Questionnaire (CSHQ), and gastrointestinal symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS). Logistic regressions were used to examine factors associated with sleep quality.
Results
A total of 176 children, consisting of 84 (47.7%) with MASLD and 92 healthy controls were included. Of these 123 (69.9%) had sleep disturbances. In unadjusted analysis, sleep disturbances were significantly more common in the MASLD group (89% vs 57%, p<0.001). However, in the final multivariate regression model adjusting for metabolic confounders, the independent predictors of sleep disturbances were low family income [odds ratio (OR)=9.56, 95% confidence interval (CI)=2.80-32.57], total GSRS score (OR=1.15, 95% CI=1.06-1.24), and Homeostatic Model Assessment of Insulin Resistance (OR=1.51, 95% CI=1.01-2.27). The presence of MASLD lost statistical significance after adjustment (p=0.554). NFS, a marker of fibrosis risk, was associated with both sleep disturbances and gastrointestinal symptoms.
Conclusion
This study showed that sleep disturbances and gastrointestinal symptoms are more common in children with MASLD, and that gastrointestinal disturbances are significantly associated with sleep disturbances. Furthermore, the results suggest that sleep disturbances may be more common in children with MASLD who have a higher estimated risk of liver fibrosis. Children with MASLD should be evaluated not only for liver health but also for extrahepatic conditions, including sleep and gastrointestinal disorders.
Keywords: Children, gastrointestinal symptoms, metabolic dysfunction-associated fatty liver disease, obesity, sleep quality
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