Peer-reviewedCC BY-NC-NDBMC gastroenterology1 Jul 2026

Sleep disorders as an emerging risk factor for liver cirrhosis and hepatocellular carcinoma: a systematic review and meta-analysis of cohort studies.

Tzu-Rong Peng^1,2,3
Ta-Wei Wu^1,4
Hung-Hong Lin⁵
Chao-Chuan Wu^6,7
Shuang-Yu Hsu⁸
Ching-Sheng Hsu^9,10

10 affiliations

¹Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
²School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, 11031, Taiwan.
³Tzu Chi University, Hualien, Taiwan.
⁴Department of Pharmacy and Master Program, Tajen University, Pingtung, Taiwan.
⁵Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
⁶Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan.
⁷School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan.
⁸Center 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.).
⁹Center 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.). [email protected].
¹⁰School of Post-Baccalaureate Chinese Medicine and School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan. [email protected].

Abstract

Background

Sleep 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

Following 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

Thirteen 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

Sleep 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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BibTeX RIS

BibTeX

@article{peng2026sleep,
  title = {{Sleep disorders as an emerging risk factor for liver cirrhosis and hepatocellular carcinoma: a systematic review and meta-analysis of cohort studies.}},
  author = {Tzu-Rong Peng and Ta-Wei Wu and Hung-Hong Lin and Chao-Chuan Wu and Shuang-Yu Hsu and Ching-Sheng Hsu},
  journal = {BMC gastroenterology},
  year = {2026},
  month = jul,
  doi = {10.1186/s12876-026-05145-1},
  url = {https://europepmc.org/article/MED/42907764},
  note = {CC BY-NC-ND},
}

RIS

TY  - JOUR
TI  - Sleep disorders as an emerging risk factor for liver cirrhosis and hepatocellular carcinoma: a systematic review and meta-analysis of cohort studies.
AU  - Tzu-Rong Peng
AU  - Ta-Wei Wu
AU  - Hung-Hong Lin
AU  - Chao-Chuan Wu
AU  - Shuang-Yu Hsu
AU  - Ching-Sheng Hsu
PY  - 2026
DA  - 2026/07/01
JO  - BMC gastroenterology
DO  - 10.1186/s12876-026-05145-1
UR  - https://europepmc.org/article/MED/42907764
AB  - Background  Sleep 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  Following 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  Thirteen 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  Sleep 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.
SN  - 1471-230X
ER  -

Abstract

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