Search Results (314)

Background: Obstructive Sleep Apnea (OSA) is one of the most prevalent sleep disorders associated with cardiovascular complications, cognitive impairments, and reduced quality of life. Early and accurate diagnosis is essential. The present gold standard, polysomnography, is expensive and resource-intensive. This work develops a non-invasive machine-learning-based framework to classify four OSA severity groups (non, mild, moderate, and severe) using tracheal breathing sounds (TBSs) and anthropometric variables. Methods: A total of 199 participants were recruited, and TBS were recorded whilst awake (wakefulness) using a suprasternal microphone. The workflow included the following steps: signal preprocessing (segmentation, filtering, and normalization), multi-domain feature extraction representing spectral, temporal, nonlinear, and morphological features, adaptive feature normalization, and a three-stage feature selection that combined univariate filtering, Shapley Additive Explanations (SHAP)-based ranking, and recursive feature elimination (RFE). The classification included training ensemble learning models via bootstrap aggregation and validating them using stratified k-fold cross-validation (CV), while preserving the OSA severity and anthropometric distributions. Results: The proposed framework performed well in discriminating among OSA severity groups. TBS features, combined with anthropometric ones, increased classification performance and reliability across all severity classes, providing proof for the efficacy of non-invasive audio biomarkers for OSA screening. Conclusions: TBS-based model’s features, coupled with anthropometric information, offer a promising alternative or supplement to PSG for OSA severity detection. The approach provides scalability and accessibility to extend screening and potentially enables earlier detection of OSA, compared to cases that might remain undiagnosed without screening. Full article

To meet 2050 climate targets, the construction sector must reduce CO₂ emissions and transition toward circular material flows. Recycled aggregates (RA) derived from construction and demolition waste (CDW) and industrial byproducts such as oil shale ash (OSA) show potential for use in concrete, although their application remains limited by standardisation and performance limitations, particularly in structural uses. This study aims to develop and evaluate low-strength, resource-efficient concrete mixtures with full replacement of natural aggregates (NA) by CDW-derived aggregates, and partial or full replacement of cement CEM II by OSA–metakaolin (MK) binder, targeting non-structural 3D-printing applications. Mechanical performance, printability, cradle-to-gate life cycle assessment, eco-intensity index, and transport-distance sensitivity for RA were assessed to quantify the trade-offs between structural performance and global warming potential (GWP) reduction. Replacing NA with RA reduced compressive strength by ~11–13% in cement-based mixes, while the aggregate type had a negligible effect in cement-free mixtures. In contrast, full cement replacement by OSA-MK binder nearly halved compressive strength. Despite the strength reductions associated with the use of waste-derived materials, RA-based cement-free 3D-printed specimens achieved ~30 MPa in compression and ~5 MPa in flexure. Replacing CEM II with OSA-MK and NA with RA lowered GWP by up to 48%, with trade-offs in the air-emission, toxicity, water and resource categories driven by the OSA supply chain. The cement-free RA mix achieved the lowest GWP and best eco-intensity, whereas the CEM II mix with RA offered the most balanced multi-impact profile. The results show that regionally available OSA and RA can enable eco-efficient, structurally adequate 3D-printed concrete for construction applications. Full article

This study determined the elastic properties of “green” concrete with cement partially replaced by oil shale ash (OSA) and reinforced with short basalt integral fibers (BIFs). Commercially available Deutsche Basalt Faser (DBF) GmbH Turbobuild Integral basalt fibers were used. There is currently a high demand both for strengthening concrete and applying ecological approaches with respect to circular economy. Oil shale ash is the byproduct of oil shale combustion. Basalt fiber is produced by melting basalt rock. Both BIF and OSA are used as additives in concrete. Cement replacement by OSA non-linearly changes the concrete’s strength properties, and the addition of BIF improves them. An experimental investigation was conducted using four-point bending tests and cube sample compression tests. Theoretical methods such as Voigt and Reuss boundaries, the Halpin–Tsai method, and the Mori–Tanaka method were used to predict the elastic properties of the fabricated samples. The theoretical models can provide useful information, although they may not fully capture the real properties observed experimentally. The results show that BIFs protect against instant brittle destruction. The experiments demonstrated an optimal OSA concentration for a fixed amount of BIF, resulting in the highest load-bearing capacity of the concrete. The addition of either 15% OSA only or 20% OSA and CBF can increase the stiffness of the concrete. This article provides guidance to the construction sector on using OSA and CBF together. Full article

Background: Osteosarcoma (OSA) is the most common type of bone cancer in canines. Novel therapies are required to prevent the growth, survival, and metastatic progression of this cancer, to increase life expectancy of patients. Immunohistochemical (IHC) studies and RNA sequencing help us gain a deeper understanding into the molecular mechanisms of the disease. Methods: We previously compared canine OSA tissues with patient matched non-tumour tissues, revealing 442 overexpressed genes within the samples. The present research used IHC staining for four of these genes in OSA tissues: G protein-coupled receptor 64 (GPR64), TOX High Mobility Group Box Family Member 3 (TOX3), Matrix Metallopeptidase 12 (MMP-12), and Forkhead Box F1 (FOXF1). H-scoring was performed to quantitatively assess protein expression and qualitatively contextualise staining locations. Additional analyses addressed whether gender or anatomical location of lesions (axial or appendicular tumours) affected protein expression. cBioPortal was employed to analyse expression and genetic alterations in patients. Results: GPR64, TOX3, MMP-12, and FOXF1 showed high mRNA expression and genetic alterations in people with OSA. GPR64, TOX3, MMP-12, and FOXF1 were all expressed in canine OSA with novel findings regarding cellular expression. Additionally, differential sex expression was revealed for GPR64 and TOX3. Potential biomarkers or therapeutic targets were identified. Conclusions: These studies, and subsequent analysis, have provided insights into the molecular mechanisms associated with OSA progression and revealed potential biomarkers for diagnostic and prognostic purposes. A deeper understanding of genetic and protein interactions will support and progress novel pathways towards diagnostic, prognostic, and treatment interventions for OSA in both veterinary and human medicine. Full article

Objective: To assess whether chronic rhinosinusitis (CRS) severity is associated with obstructive sleep apnea (OSA) in adult people with cystic fibrosis (pwCF). Methods: We conducted a retrospective single-center study of 44 adults with CF who underwent overnight polysomnography (PSG), Epworth Sleepiness Scale (ESS) assessment, and sinus computed tomography (CT). CRS severity was quantified using the Lund–Mackay score (LMS) and the main nasal cavity score (MNCS). OSA was defined by Apnea–Hypopnea Index (AHI) thresholds per American Academy of Sleep Medicine criteria. Results: Participants had a mean age of 31.1 ± 8.4 years and a mean percent predicted FEV1 of 51.8 ± 15.7. Sinus CT showed radiological evidence of CRS in all participants. Mean AHI was 5.3 ± 4.4/h; 48% had AHI ≥ 5/h. There were no significant differences between pwCF with and without OSA in age, sex, BMI, lung function, total sleep time, sleep efficiency, or ESS score (all p > 0.05). Mean LMS and MNCS did not differ between OSA and non-OSA groups (both p > 0.05), and neither score correlated with PSG parameters or ESS (all p > 0.05). Receiver operating characteristic (ROC) analysis demonstrated low discriminative ability of LMS and MNCS for predicting OSA (AUCs < 0.70, p < 0.05). Conclusions: In this cohort of adults with CF, CT-based CRS severity was not associated with OSA. Given the substantial prevalence of OSA observed, PSG screening should be considered irrespective of CRS severity. Full article

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by repeated upper airway collapse during sleep, significantly impacting quality of life. Orthodontists are increasingly recognized for their role in screening and managing anatomical factors contributing to airway obstruction. One such intervention is rapid maxillary expansion (RME), originally developed to address transverse maxillary deficiencies but now also studied for its influence on nasal and oropharyngeal airway dimensions. This literature review evaluates the effects of maxillary palatal expansion on airway volume and respiratory function. Evidence consistently shows increases in nasal cavity volume and reductions in nasal airway resistance, particularly in patients treated before the peak of skeletal growth. Some studies reported improvements in sleep outcomes and enhanced oxygen saturation following MARPE in adults with OSA. Results regarding changes in oropharyngeal volume were more variable, with several studies showing significant expansion. Factors influencing outcomes include patient age, skeletal maturity, appliance type, and aging modality. Hybrid and bone-borne expanders generally demonstrated greater skeletal effects compared to tooth-borne devices, though statistical significance was not always reached. While MARPE has shown promising results in non-obese adults with OSA, long-term stability of airway improvements and translation into consistent functional respiratory benefits remain uncertain. Overall, maxillary expansion demonstrates measurable skeletal and airway changes, with the greatest respiratory improvements in growing patients and selected adult populations. Incorporating patient-reported outcomes and standardized polysomnographic measures in future trials will be critical to determine whether these structural gains consistently translate into durable improvements in sleep-disordered breathing and quality of life. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder characterized by repeated episodes of upper airway obstruction during sleep, leading to intermittent hypoxia and fragmented sleep architecture. Orofacial myofunctional therapy (OMT) has emerged as a promising non-invasive approach to improving airway patency in individuals with mild-to-moderate OSA. However, the role of sleep ergonomics—including sleep posture and pillow support—in enhancing OMT outcomes remains underexplored. This study aimed to evaluate whether ergonomic interventions could augment the therapeutic effects of OMT in adult patients with mild-to-moderate OSA. Methods: A 12-week prospective cohort study was conducted involving 60 adult participants diagnosed with mild-to-moderate OSA. All participants underwent a structured orofacial myofunctional therapy (OMT) program comprising exercises for tongue elevation, lip seal enhancement, and soft palate strengthening. In addition, ergonomic instructions were provided regarding optimal sleeping posture and pillow adjustment. Compliance with ergonomic practices was monitored weekly using infrared night-vision cameras and reviewed by a blinded sleep technician. Pre- and post-intervention assessments included apnea–hypopnea index (AHI), Pittsburgh Sleep Quality Index (PSQI), and Ep-worth Sleepiness Scale (ESS). Results: Statistically significant improvements were observed in all measured parameters following the intervention. AHI scores reduced from 18.2 ± 4.5 to 10.6 ± 3.9 events/hour (p < 0.001), PSQI scores improved from 11.3 ± 2.1 to 6.5 ± 1.8 (p < 0.001), and ESS scores declined from 13.7 ± 2.6 to 7.4 ± 2.0 (p < 0.001). Participants with high adherence to ergonomic recommendations demonstrated significantly greater clinical improvements compared to less adherent individuals. Conclusions: The combination of ergonomic sleep posture interventions with OMT was associated with positive improvements in sleep-related outcomes, comparable to or in some cases better than those reported in previous studies evaluating these interventions independently. As an observational cohort without a control arm, this study cannot establish causality but provides preliminary evidence to guide the design of future randomized clinical trials. Full article

Background/Objectives: Obesity is a significant risk factor for obstructive sleep apnea (OSA); however, conventional anthropometric measures, such as body mass index (BMI), may not fully reflect the physiological burden associated with adiposity. The triponderal mass index (TMI) has been proposed as an alternative anthropometric indicator, while inflammation-related biomarkers have emerged as potential complementary tools for characterizing OSA severity. This study aimed to evaluate the relationships between BMI, TMI, hypoxemia, and systemic inflammation, and to assess whether combining anthropometric indices with inflammatory biomarkers improves the identification of severe OSA. Methods: In this retrospective cross-sectional study, 238 adults undergoing full-night polysomnography were classified into four groups: non-OSA, mild OSA, moderate OSA, and severe OSA, based on the apnea–hypopnea index (AHI). Anthropometric indices, polysomnographic parameters, and a comprehensive panel of laboratory biomarkers—including C-reactive protein (CRP), neutrophil- and platelet-derived inflammatory indices, prognostic nutritional index (PNI), CRP-to-albumin ratio (CAR), and CRP-to-lymphocyte ratio (CLR)—were analyzed. Associations were evaluated using Spearman correlation analyses, and diagnostic performance for severe OSA (AHI ≥ 30 events/h) was assessed using receiver operating characteristic (ROC) analyses, DeLong tests, and multivariable models. Results: Both BMI and TMI increased progressively with OSA severity (both p < 0.001) and showed comparable correlations with AHI and nocturnal oxygenation parameters. ROC analyses demonstrated similar discriminative performance for severe OSA (BMI AUC = 0.834; TMI AUC = 0.823; p = 0.229). Among inflammatory biomarkers, CRP, multi-inflammatory index (MII), CAR, and CLR showed moderate diagnostic accuracy. Among the evaluated markers, serum albumin (AUC = 0.836) and PNI demonstrated the highest diagnostic accuracy (AUC = 0.994). A combined model integrating BMI or TMI with PNI achieved near-perfect discrimination for severe OSA (BMI-based AUC = 0.9956; TMI-based AUC = 0.9969), while the addition of CRP-based inflammatory markers did not yield meaningful incremental benefit. Conclusions: BMI and TMI exhibit comparable performance in relation to OSA severity, hypoxemia, and systemic inflammation, with no clear superiority of TMI over BMI in adult patients. Inflammation-related biomarkers—particularly PNI—provide additional discriminatory value beyond anthropometric measures alone. Integrating simple biochemical markers with anthropometric and polysomnographic parameters may enhance risk stratification and identification of severe OSA phenotypes. Full article

Background/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 due to methodological limitations, heterogeneity, and imprecision. High-quality, longitudinal trials are needed. Full article

Obstructive sleep apnea syndrome (OSAS) is a common disorder with established cardiovascular and metabolic risks. Positive airway pressure (PAP) therapy remains the standard of care; however, its long-term effectiveness is often limited by poor compliance and adherence. This study sought to explore clinical and device-related factors influencing PAP use, with emphasis on pressure variability in Auto-PAP users and comorbidities such as COPD. We performed a retrospective analysis of 359 patients with OSAS who were treated with CPAP, Auto-PAP, or BiPAP devices at the Marius Nasta Institute of Pneumology between January 2022 and July 2024. Compliance was measured as the proportion of days the device was used, whereas adherence was estimated through average nightly hours of use. Patient data were stratified by demographic, clinical, and device-related characteristics. Statistical testing included Chi-square, Wilcoxon rank-sum, and correlation analyses. Demographics did not significantly differ between compliant and non-compliant groups. Notably, Auto-PAP users with greater pressure variability (>10 cm H₂O) had significantly lower compliance (p = 0.001). Nasal mask preference was also associated with poorer compliance (p = 0.030). Multivariate models further revealed that atrial fibrillation reduced the likelihood of good adherence (OR = 0.319, 95% CI 0.137–0.746). These results highlight the importance of monitoring pressure variability, device type, and comorbidities to personalize PAP therapy and improve long-term outcomes. Full article

Background: Obstructive sleep apnea (OSA) is a heterogeneous disorder associated with substantial cardiometabolic and neurocognitive morbidity. Although the apnea–hypopnea index (AHI) remains the conventional measure of OSA severity, it only partially reflects the underlying pathophysiological complexity. Growing evidence indicates that nocturnal hypoxemia may be a more powerful marker of adverse outcomes than event frequency alone. Therefore, this study aimed to identify distinct OSA phenotypes based on oximetry-derived features and to assess whether these profiles offer additional clinical insight beyond traditional AHI-based classification. Methods: This multicenter retrospective study, part of the Living with OSA and CPAP: The Apulia Region Experience project, included 1386 adults diagnosed with OSA across 15 sleep centers in Southern Italy. Standardized clinical, anthropometric, and polysomnographic (PSG) data were collected. Hierarchical clustering analysis was performed based on PSG oximetry-derived variables. Resulting clusters were compared across demographic, clinical, hypoxemic, and therapeutic features. Results: Three reproducible clusters emerged. Cluster 1 (mild–non-obese) included younger, leaner patients with lower AHI (22.9 ± 10.5 events·h⁻¹), minimal desaturation (T90 5.6 ± 7.6%), and limited comorbidities. Cluster 2 (severe–obese–hypoxemic) represented the most critical phenotype, characterized by marked obesity (BMI 39.2 ± 8.2 kg·m⁻²), severe OSA (AHI 74.9 ± 17.9 events·h⁻¹), profound nocturnal hypoxemia (T90 51.5 ± 28.2%), and a high prevalence of metabolic disorders (76%), requiring higher CPAP pressures and frequent oxygen supplementation. Cluster 3 (older–comorbid) comprised older males (63.7 ± 11.8 years) with moderate-to-severe OSA (AHI 44.8 ± 15.2 events·h⁻¹) and multiple cardiometabolic comorbidities. Conclusions: Oximetry-derived variables identify distinct and clinically meaningful OSA phenotypes that extend beyond traditional AHI-based classification. Recognizing hypoxemia-driven subtypes could improve risk stratification and enable more personalized management strategies in clinical practice. Full article

Background/Objectives: This study aimed to quantitatively and noninvasively evaluate the changes in the Genioglossus (GG) and Geniohyoid (GH) muscles in patients with Obstructive Sleep Apnea (OSA) using ultrasonography (US) and shear wave elastography (SWE). Methods: This prospective study included 94 adults (18–73 years) who underwent polysomnography (27 normal; 67 OSA). GG and GH muscle thickness was measured with US, and stiffness with SWE. Participants were grouped as non-OSA (Group 0) and OSA (Group 1). OSA patients were further divided by apnea–hypopnea index (AHI) into mild, moderate, and severe (Groups 1–3), forming four groups including controls. Results: No significant differences were observed in genioglossus or geniohyoid muscle thickness between groups. Shear wave elastography revealed significantly higher stiffness values for both the genioglossus and geniohyoid muscles bilaterally in OSA patients compared with non-OSA individuals (approximately 2.7 m/s vs. 2.4–2.5 m/s, p < 0.01). Geniohyoid muscle stiffness on both sides increased progressively with OSA severity, with significantly higher values in severe compared with mild OSA (p < 0.05). In contrast, genioglossus stiffness did not differ significantly across OSA severity subgroups. Conclusions: In patients with OSA, GH and GG muscle thickness remains unchanged, but their stiffness measured by SWE increases. GH stiffness also rises with increasing disease severity. These results indicate that GG and GH muscle stiffness may serve as useful noninvasive markers for OSA. Full article

Purpose: The aim of this study was to investigate the association between obstructive sleep apnea (OSA) and the prevalence of dry eye disease (DED) and meibomian gland dysfunction (MGD) using the All-of-Us Research Program (AoURP) dataset from a large, demographically diverse U.S. population. Methods: In this cross-sectional, matched case–control study, participants with documented OSA were exactly matched 1:3 by age, gender, race, and ethnicity to controls without OSA. Associations between OSA and DED and MGD were evaluated using univariate and multivariate logistic regression models adjusted for obesity, diabetes, smoking, hypertension, hyperlipidemia, hypothyroidism, and cardiovascular disease at the time of enrollment. Results: Among the 628,649 AoURP participants, 59,804 individuals had OSA and 179,412 matched controls were identified with the same demographics (mean age 61.95 years; 54.0% female; 12.5% Hispanic; 62.3% non-Hispanic White; 15.5% non-Hispanic Black). Compared to controls, OSA participants had significantly higher rates of smoking (13.7% vs. 10.9%), obesity (68.4% vs. 13.2%), diabetes (43.3% vs. 11.7%), hypertension (76.4% vs. 28.2%), hyperlipidemia (74.5% vs. 27.5%), hypothyroidism (24.7% vs. 8.1%), and cardiovascular disease (43.1% vs. 12.8%) (all p < 0.001). Compared to matched controls, the prevalence of DED was significantly higher in the OSA group (19.4% vs. 5.8%), with an adjusted odds ratio (OR) of 1.76 (95% confidence interval (95% CI), 1.70–1.82; p < 0.001). MGD prevalence was also higher in the OSA group (2.6% vs. 1.0%), with an adjusted OR of 1.43 (95% CI, 1.32–1.55; p < 0.001). Conclusions: In this large, demographically diverse U.S. population, obstructive sleep apnea was independently associated with a higher prevalence of both dry eye disease and meibomian gland dysfunction. These findings provide large-scale U.S. evidence and suggest that screening for ocular surface disease may be warranted in patients with OSA to improve detection and management. Full article

Background/Objectives: Achondroplasia is linked to distinctive ear–nose–throat (ENT) morbidity, yet quantitative age-structured profiles and actionable correlates remain incompletely defined. This study mapped ENT phenotypes in a consecutive cohort and examined the achondroplasia subset for prevalence, co-occurrence, age dynamics, and parsimonious risk models. Methods: Retrospective observational analysis (1 February 2023–31 January 2025). Narrative “ENT complications” were dictionary-mapped to five non-exclusive categories: otitis media, adenotonsillar/apnea—obstructive sleep apnea (OSA), audiologic/Eustachian-tube dysfunction (ETD), nasopharyngeal/upper-respiratory (URT), and extra-ENT. Proportions used Wilson 95% confidence intervals (CIs). Pairwise associations used Fisher’s exact tests with Benjamini–Hochberg false discovery rate (BH-FDR). Age was summarized by a four-level age-class schema (AC-4: 0–2, 3–5, 6–12, ≥13 years) and a two-level sensitivity contrast (AC-2: ≤5 vs. >5 years). Results: Of 83 patients, 64 (77.1%) had achondroplasia. In achondroplasia, otitis media occurred in 51.6% and OSA in 28.1%; versus non-achondroplasia, ARDs were +35.8 and +28.1 percentage points (BH-FDR adjusted). Within achondroplasia, otitis media co-occurred with OSA (odds ratio [OR] 4.97; q = 0.012) and with ETD (OR 7.25; q = 0.012). OSA increased across AC-4 to school age (p-trend = 0.0548). In parsimonious models, otitis media independently predicted ETD and OSA. A five-item ENT-burden score discriminated otologic and adeno-tonsillar interventions (AUC 0.83–0.93). Conclusions: Achondroplasia shows a concentrated ENT burden dominated by otitis media and OSA, with large adjusted absolute differences versus non-achondroplasia. Otitis media functions as a practical clinical marker for both OSA and ETD, while a compact burden score may assist intervention triage. Full article

The absence of a unifying pathogenetic mechanism in metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), has significantly hindered therapeutic progress. Appreciation that the delivery of excessive amounts of calories to the liver via the portal circulation might be a key parallel between MASLD and the twin steatotic liver disease, alcohol-related liver disease (ALD), establishes a consolidated framework that could guide rational drug design and precise therapeutic approaches. This review contends that, in both ALD and MASLD, the unique dual blood supply to the liver, from both portal vein and hepatic artery as well as the distinctive blood flow control physiology, prevents hepatic arterial oxygen delivery from adequately compensating for the increased metabolic demands induced by excess caloric intake—alcohol in ALD and food in MASLD—resulting in hepatocellular injury. Over four decades ago, Lautt postulated that this ‘oxygen-nutrient mismatch’ could play a role in ALD. We have extended this paradigm to MASLD, theorizing that analogous mechanisms may be involved in both conditions. Evidence that comorbidities, which are associated with recurrent episodes of hypoxemia, such as obstructive sleep apnea (OSA), exacerbate MASLD progression, supports this. ALD is less strongly linked to metabolic syndrome than MASLD. This may be due to inherent differences in hepatic substrate processing. Carbohydrates, lipids, and proteins undergo diverse and flexible cytosolic metabolic pathways, especially under metabolic stress. In contrast, hepatic ethanol metabolism is predominantly linear and obligately oxidative, providing limited metabolic adaptability. Future perspectives could focus on rectifying the imbalance between hepatic oxygen delivery and nutrient availability. This might be accomplished by attenuating hepatic caloric excess using emerging pharmacotherapies for weight reduction, augmenting hepatic oxygenation through hyperbaric oxygen therapy, or increasing hepatic arterial blood flow with agents such as obeticholic acid. Furthermore, enhancement of hepatic basal metabolic activity with thyroid hormone receptor-β agonists, like resmiritom may confer similar therapeutic effects. Full article