{
  "abstract": "Background\n\nSleep 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.Methods\n\nFollowing 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.Results\n\nThirteen 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.Conclusions\n\nSleep 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.",
    "School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, 11031, Taiwan.",
    "Tzu Chi University, Hualien, Taiwan.",
    "Department of Pharmacy and Master Program, Tajen University, Pingtung, Taiwan.",
    "Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.",
    "Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan.",
    "School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan.",
    "Center for Digestive Medicine, Department of Medical Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Road, Tanzi District, Taichung City, 42743, Taiwan (R.O.C.).",
    "Center for Digestive Medicine, Department of Medical Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Road, Tanzi District, Taichung City, 42743, Taiwan (R.O.C.). hsu.chingsheng@gmail.com.",
    "School of Post-Baccalaureate Chinese Medicine and School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan. hsu.chingsheng@gmail.com."
  ],
  "article_type": "systematic review",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Tzu-Rong Peng"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Ta-Wei Wu"
    },
    {
      "affs": [
        4
      ],
      "name": "Hung-Hong Lin"
    },
    {
      "affs": [
        5,
        6
      ],
      "name": "Chao-Chuan Wu"
    },
    {
      "affs": [
        7
      ],
      "name": "Shuang-Yu Hsu"
    },
    {
      "affs": [
        8,
        9
      ],
      "name": "Ching-Sheng Hsu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/98zngb21eegxc.bib",
  "cited_by": 0,
  "doi": "10.1186/s12876-026-05145-1",
  "fulltext_url": "https://europepmc.org/articles/PMC13688965",
  "id": "98zngb21eegxc",
  "issns": [
    "1471-230X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42907764",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC799-869"
    ],
    [
      "openalex",
      "3205|Sleep and related disorders"
    ]
  ],
  "openalex": "W7171055976",
  "pdf_url": "https://europepmc.org/articles/PMC13688965?pdf=render",
  "pmcid": "PMC13688965",
  "pmid": "42907764",
  "published": "2026-07-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/98zngb21eegxc.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:59Z",
      "native_id": "MED:42907764",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42907764"
    },
    {
      "first_seen": "2026-10-30T13:46:03Z",
      "native_id": "6cbeaad668ee4c3a9856634fe7ed64cf",
      "source": "doaj",
      "url": "https://doi.org/10.1186/s12876-026-05145-1"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RC799-869",
      "subfield": "general"
    }
  ],
  "title": "Sleep disorders as an emerging risk factor for liver cirrhosis and hepatocellular carcinoma: a systematic review and meta-analysis of cohort studies.",
  "title_text": "Sleep disorders as an emerging risk factor for liver cirrhosis and hepatocellular carcinoma: a systematic review and meta-analysis of cohort studies.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:46:03Z",
  "url": "https://research.draconitic.com/paper/98zngb21eegxc",
  "venue": "BMC gastroenterology",
  "versions": []
}