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A systematic review assessed whether continuous positive airway pressure (CPAP) changes hepatic and metabolic outcomes in adults with both conditions. Searches in PubMed, Web of Science, and CINAHL included randomized and observational studies using CPAP or other interventions. Across eight studies, CPAP showed modest, inconsistent effects on liver enzymes and small metabolic improvements, with limited evidence for steatosis, fibrosis, or body composition benefits, highlighting the need for high-quality longitudinal trials.",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/does-continuous-positive-airway-pressure-improve-liver-outcomes-in-masld-with-obstructive-sleep-apnea-a-systematic-review/461583/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/does-continuous-positive-airway-pressure-improve-liver-outcomes-in-masld-with-obstructive-sleep-apnea-a-systematic-review/461583.png","ImageObject",300,407,{"name":92,"@type":93},"jayni","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-05","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":19},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"What question does the systematic review investigate?","Question",{"text":112,"@type":113},"Whether continuous positive airway pressure (CPAP) improves liver-related outcomes in adults with MASLD and obstructive sleep apnea (OSA).","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which types of studies were included and how were outcomes measured?",{"text":117,"@type":113},"The review included randomized controlled trials and observational studies and evaluated outcomes such as liver stiffness, fat content, liver enzymes, fibrosis scores, HbA1c, lipids, and anthropometrics.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the main findings regarding CPAP’s effects?",{"text":121,"@type":113},"CPAP led to modest and inconsistent reductions in alanine aminotransferase and aspartate aminotransferase, small improvements in HbA1c and triglycerides, and minimal changes in liver stiffness, steatosis, and body composition.",{"name":123,"@type":110,"acceptedAnswer":124},"Why is the overall evidence considered limited?",{"text":125,"@type":113},"Evidence for improvements in steatosis, fibrosis, and body composition was limited, and certainty was constrained by methodological limitations, heterogeneity, and imprecision.","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},461583,1790791279,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":19,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":143,"language":144,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":145,"faqs":146,"seo_title":147,"seo_description":67,"update_tm":148,"read_time":36},3985747859343,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Systematic Review  \nDoes Continuous Positive Airway Pressure Improve Liver Outcomes in MASLD with Obstructive Sleep Apnea? A Systematic Review  \nTheja V. Channapragada 1, Clinton R. Brenner 2, Keven Guruswamy 3, Rewanth Katamreddy 4, Alwyn T. Pandian 5, Vyshnavi Pendala 6, Jaydon J. Sam 7, Jonathan G. Stine 1, Michael J. Brenner 8, * and Vinciya Pandian 7,9,10  \nAcademic Editor: Yüksel Peker  \nReceived: 24 November 2025  \nRevised: 18 December 2025  \nAccepted: 25 December 2025  \nPublished: 27 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA; [tchannapragada@pennstatehealth.psu.edu](tchannapragada@pennstatehealth.psu.edu) (T.V.C.); [jstine@pennstatehealth.psu.edu](jstine@pennstatehealth.psu.edu) (J.G.S.)  \n2 College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI 48109, USA; [clintb@umich.edu](clintb@umich.edu)  \n3 College of Natural and Mathematical Sciences, University of Maryland Baltimore County, Catonsville, MD 21250, USA; [kgurusw1@umbc.edu](kgurusw1@umbc.edu)  \n4 Guthrie Medical Center, Sayre, PA 18840, USA; [rewanth.katamreddy@guthrie.org](rewanth.katamreddy@guthrie.org)  \n5 College of Education, The Pennsylvania State University, University Park, PA 16802, USA; [atp5521@psu.edu](atp5521@psu.edu)  \n6 West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901, USA; [vp3sm@virginia.edu](vp3sm@virginia.edu)  \n7 Center for Immersive Learning and Digital Innovation, The Pennsylvania State University, University Park, PA 16802, USA; [jjs8788@psu.edu](jjs8788@psu.edu) (J.J.S.); [vpandian@psu.edu](vpandian@psu.edu) (V.P.)  \n8 Department of Otolaryngology—Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI 48104, USA  \n9 Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA 16802, USA  \n10 Department of Otolaryngology—Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA  \n* [Correspondence: mbren@med.umich.edu](Correspondence: mbren@med.umich.edu)  \nAbstract  \nBackground/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) often coexists with obstructive sleep apnea (OSA) due to overlapping metabolic risk factors. Whether continuous positive airway pressure (CPAP) influences hepatic outcomes in MASLD remains uncertain. This systematic review, using updated criteria for MASLD, evaluated the effects of OSA treatment on liver and metabolic outcomes. Methods: PubMed, Web of Science, and CINAHL were searched for randomized controlled trials (RCTs) and observational studies in adults with MASLD and OSA treated with CPAP, lifestyle interventions, pharmacotherapy, or surgery. Outcomes included liver stiffness, fat content, enzymes, fibrosis scores, HbA1c, lipids, and anthropometrics. Risk of bias was assessed with RoB 2 (RCTs) and ROBINS-I (non-randomized studies) and certainty of evidence with GRADE. Results: Eight studies (three RCTs, five observational; n = 1006; 73.5% male) met criteria. Studies evaluated CPAP for from 4 weeks to 3 years, with adherence ≥ 4 h/night in most. CPAP produced modest, inconsistent reductions in alanine aminotransferase and aspartate aminotransferase, small improvements in HbA1c and triglycerides, and minimal changes in liver stiffness, steatosis, weight, or anthropometrics. No RCT demonstrated significant improvement in fibrosis or steatosis. Risk of bias was low in one RCT,“some concerns” in two, and moderate in observational studies; one study had serious confounding risk. Conclusions: CPAP may modestly improve liver enzymes and select metabolic parameters in MASLD with OSA, but evidence for salutary effects on steatosis, fibrosis, and body composition is limited. Level of evidence was low","cbCainflft86sBtt","https://ap.wps.com/l/cbCainflft86sBtt","pdf",1570068,16,"English","# Abstract\n## Background/Objectives\n## Methods\n## Results\n## Conclusions\n# 1. Introduction","[{\"question\":\"What question does the systematic review investigate?\",\"answer\":\"Whether continuous positive airway pressure (CPAP) improves liver-related outcomes in adults with MASLD and obstructive sleep apnea (OSA).\"},{\"question\":\"Which types of studies were included and how were outcomes measured?\",\"answer\":\"The review included randomized controlled trials and observational studies and evaluated outcomes such as liver stiffness, fat content, liver enzymes, fibrosis scores, HbA1c, lipids, and anthropometrics.\"},{\"question\":\"What were the main findings regarding CPAP’s effects?\",\"answer\":\"CPAP led to modest and inconsistent reductions in alanine aminotransferase and aspartate aminotransferase, small improvements in HbA1c and triglycerides, and minimal changes in liver stiffness, steatosis, and body composition.\"},{\"question\":\"Why is the overall evidence considered limited?\",\"answer\":\"Evidence for improvements in steatosis, fibrosis, and body composition was limited, and certainty was constrained by methodological limitations, heterogeneity, and imprecision.\"}]","Does Continuous Positive Airway Pressure Improve Liver Outcomes in MASLD with Obstructive Sleep Apnea - A Systematic Review | PDF",1790761922]