Background: Both sleep deprivation and poor sleep quality are associated with insulin resistance, type 2 diabetes (T2D), and obesity, which are conditions closely linked to metabolic dysfunction-associated steatotic liver disease (MASLD). Some studies have suggested a relationship between sleep disturbances and MASLD; however, only few have specifically focused on the interplay between sleep behavior and MASLD in the context of T2D. Aim: To assess whether abnormal sleep habits are independently associated with MASLD in T2D patients. Subjects and methods. The study was performed on T2D patients consecutively enrolled in the TESEO study. Sleep habits were evaluated using the Munich Chronotype Questionnaire. Sleep debt (SD) was calculated as the difference between mean sleep duration on free days and workdays and a SD ≥120 min was considered abnormal (SD+). Liver steatosis and fibrosis were assessed with Fibroscan® and defined according to a Controlled Attenuation Parameter (CAP) ≥270 dB/m and a liver stiffness value >7 kPa, respectively. Patients with history of self-reported alcohol abuse, other causes of liver disease, liver cirrhosis, or using an alarm clock on free days were excluded. Results: Enrolled patients (n=245, age 62.1±7.7 years, 53.5% males) had a short duration of T2D [1.47 (0.47-5.1) years] and a good glycemic control (HbA1c 48.6±11.5 mmol/mol). Patients in the SD+ group (n=36, 14.7%) were younger (p=0.01), had higher HbA1c levels (p=0.03), and a greater prevalence of liver steatosis (83.3 vs 52.6%, p<0.001) and fibrosis (19.4 vs 8.1%, p=0.04) compared with the SD- group. In logistic regression analysis, a SD ≥120 min was associated with a 9.9 increased odds ratio (95%CI 2.9-33.9) of liver steatosis independent of age, gender, BMI, HbA1c, triglycerides, adherence to Mediterranean diet, and physical activity, while no independent association was found with liver fibrosis after correction for age, gender, and CAP values. Conclusion: Our results suggest that sleep debt is independently associated with the presence of MASLD in patients with T2D.