Integrating Lifestyle in Pediatric Subspecialty for MASLD sleep disorders and Obesity care

Presentation Summary: This session presents a lifestyle medicine framework through the combined perspectives of a pediatric gastroenterologist and a Sleep Medicine specialist, focusing on the bidirectional relationship between sleep disorders including poor sleep and obstructive sleep apnea with MASLD. Participants will explore shared mechanisms linking sleep disturbance, insulin resistance, inflammation, and hepatic steatosis. Evidence-based screening and treatment strategies will be reviewed, followed by case-based discussion demonstrating integrated sleep and lifestyle interventions in pediatric obesity care.

Childhood and adolescence are critical periods for liver and metabolic health across the lifecourse. MASLD frequently develops during this time, paralleling rising rates of pediatric obesity and sleep disorders. This session will take an evidence-based lifestyle medicine approach to MASLD, emphasizing that poor sleep and obstructive sleep apnea (OSA) are both contributors to and consequences of metabolic liver disease, from the perspectives of a pediatric gastroenterologist and pediatric sleep Medicine specialist.

Participants will examine the bidirectional relationship between obesity, sleep disturbance, and MASLD. Short sleep duration and poor sleep quality increase obesity and insulin resistance risk, while excess adiposity increases the prevalence and severity of obstructive sleep apnea (1,3). We will review pathophysiologic mechanisms shared by OSA and MASLD, including intermittent hypoxia, oxidative stress, systemic inflammation, hypothalamic–pituitary–adrenal axis activation, circadian dysregulation, and altered hepatic lipid metabolism.

MASLD itself may further worsen sleep health through systemic inflammation, metabolic dysregulation, and increased risk of sleep-related breathing disorders (SRBD). Obstructive sleep apnea is the most prevalent SRBD in children with obesity and MASLD and has been associated with worsened cardiometabolic risk profiles and liver disease severity independent of body mass index.

Evidence-based screening approaches, including polysomnography and actigraphy, will be reviewed alongside lifestyle-based interventions such as sleep hygiene, behavioral therapy, and treatment of SRBD. Case-based presentations will illustrate how integrated sleep and lifestyle medicine strategies can be incorporated into pediatric MASLD care to improve metabolic and hepatic outcomes, which ultimately lead to improved sleep-related breathing disorders.