Scoring System:

Risk Factor	Points	Odds Ratio
BMI ≥32 kg/m²	2	3.2 (1.8-5.7)
Type 2 Diabetes	3	∞ (100% prevalence)
Hypertension	1	2.1 (1.2-3.8)
Male Gender	1	1.3 (0.8-2.1)
Dyslipidemia	1	2.3 (1.3-4.1)

Interpretation:

Score	Risk Category	Clinical Action
0-2	Low Risk	Low probability of OSA
3-4	Intermediate Risk	Consider sleep study
5-8	High Risk	High priority for sleep study

Obstructive Sleep Apnea (OSA)

Definition

OSA is a sleep-related breathing disorder characterized by repetitive episodes of complete (apnea) or partial (hypopnea) upper airway obstruction during sleep, resulting in reduced or absent breathing despite respiratory effort.

Diagnostic Criteria (AASM)

OSA is diagnosed when either criterion A or B is met:

A. Signs/Symptoms + AHI ≥5:

• Excessive daytime sleepiness
• Loud snoring
• Witnessed breathing interruptions
• Awakening with gasping/choking
• Non-restorative sleep
• Fatigue or insomnia
• Morning headaches
• Cognitive impairment

B. AHI ≥15 (regardless of symptoms)

Severity Classification

Severity	AHI (events/hour)	Clinical Features
Mild	5-14	Minimal symptoms, mild sleepiness
Moderate	15-29	Moderate sleepiness, affects daily activities
Severe	≥30	Severe sleepiness, significant impairment

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Definition

MASLD (formerly NAFLD) is characterized by hepatic steatosis in the presence of at least one cardiometabolic risk factor, without significant alcohol consumption or other causes of liver disease.

Diagnostic Criteria

MASLD requires ALL of the following:

1. Hepatic steatosis (>5% of hepatocytes)
2. At least one cardiometabolic risk factor:
   • BMI ≥25 kg/m² (≥23 in Asians)
   • Type 2 diabetes
   • Hypertension
   • Hypertriglyceridemia (≥150 mg/dL)
   • Low HDL-C (<40 mg/dL men, <50 mg/dL women)
   • Prediabetes
   • HOMA-IR ≥2.5
   • hsCRP >2 mg/L
3. No significant alcohol use (<30g/day men, <20g/day women)
4. No other causes of steatosis

FibroScan Assessment

Parameter	Grade	Values
CAP Score (Steatosis)	S0 (Normal)	<238 dB/m
	S1 (Mild)	238-260 dB/m
	S2 (Moderate)	260-290 dB/m
	S3 (Severe)	≥290 dB/m
LSM (Fibrosis)	F0-F1	2-7 kPa
	F2	7.5-10 kPa
	F3	10-14 kPa
	F4 (Cirrhosis)	≥14 kPa

Management of OSA with MASLD

Integrated Treatment Approach

1. CPAP Therapy: First-line for moderate-severe OSA
2. Weight Loss: Target 7-10% reduction
3. Metabolic Control: Optimize diabetes, hypertension, dyslipidemia
4. Lifestyle Modification: Diet, exercise, alcohol cessation
5. Pharmacotherapy:
   • GLP-1 agonists (tirzepatide, semaglutide)
   • Resmetirom for MASH with fibrosis
   • Vitamin E for non-diabetic NASH
6. Regular Monitoring: FibroScan every 6-12 months