SynthesisBMC gastroenterology2026
Sleep disorders as an emerging risk factor for liver cirrhosis and hepatocellular carcinoma: a systematic review and meta-analysis of cohort studies.
Synthesis in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSleep disorders are increasingly recognized as contributors to metabolic dysfunction and chronic liver disease, but their associations with hepatocellular carcinoma (HCC) and cirrhosis remain unclear. We conducted a systematic review and meta-analysis to evaluate the relationship between sleep disorders and liver-related outcomes.
methodsFollowing PRISMA guidelines (PROSPERO: CRD420261342781), we searched PubMed, Embase, Web of Science, and the Cochrane Library through February 2026 for cohort studies assessing sleep disorders and liver outcomes. Adjusted hazard ratios (HRs) or odds ratios (ORs) were pooled using random-effects models. Subgroup and sensitivity analyses were performed, and risk of bias was assessed using ROBINS-I.
resultsThirteen cohort studies were included. Overall, sleep disorders were associated with an increased risk of liver-related outcomes (HR 1.49; 95% CI 1.22-1.81; I² = 96%). Insomnia was significantly associated with increased risk (HR 1.39; 95% CI 1.28-1.49), whereas obstructive sleep apnea showed a non-significant trend (HR 1.80; 95% CI 0.91-3.58). Sleep disorders were linked to higher risks of HCC (HR 1.42; 95% CI 1.15-1.77) and unspecified liver cancer (HR 1.26; 95% CI 1.01-1.57), but not cirrhosis. Findings were robust in sensitivity analyses, with no significant publication bias.
conclusionsSleep disorders, particularly insomnia, are associated with increased risks of HCC and liver-related outcomes. These findings highlight sleep disturbances as potentially modifiable risk factors in liver disease progression.
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