Sleep disorders increase the risk of osteoporosis: a nationwide population-based cohort study

Yen, Chia-Ming; Kuo, Chi-Ling; Lin, Ming-Chia; Lee, Chun-Feng; Lin, Kuan‐Yu; Lin, Cheng‐Li; Chang, Shang‐Tzen; Sung, Fung‐Chang; Kao, Chia‐Hung

doi:10.1016/j.sleep.2014.07.005

Cited by 28 publications

(27 citation statements)

References 37 publications

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“…It is well known that sleep problems have a detrimental effect on physical health, and estimates suggest 70% of individuals with PTSD have sleep disturbances (Ohayon and Shapiro, 2000). It is therefore plausible that sleep dysfunction drives the relationship between PTSD and particular health problems, given that associations have been established between all four relevant physical conditions (sleep disorder, migraine, osteoporosis or osteopenia, and respiratory diseases) and dysfunctional sleep (Dikmen et al, 2014; Leng et al, 2016; Yen et al, 2014). Additionally, sleep disorders evidenced the largest effect size with subthreshold and full PTSD in comorbidity analyses, further emphasizing its importance.…”

Section: Discussionmentioning

confidence: 99%

Physical health conditions associated with full and subthreshold PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study

El‐Gabalawy

Blaney

Tsai

et al. 2018

Journal of Affective Disorders

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Background: While both full and subthreshold posttraumatic stress disorder (PTSD) may be linked to physical conditions, contemporary population-based data on these associations in military veterans are scarce. Further, little is known about how component aspects of PTSD, which is a heterogeneous disorder, may relate to physical conditions in this population. Methods: Data were analyzed from a population-based sample of 3157 U.S. military veterans who participated in the 2011 National Health and Resilience in Veterans Study. Multiple logistic regression analyses evaluated associations between full and subthreshold PTSD, and physical conditions. Results: A total 6.1% of the sample met screening criteria for full PTSD and 9.0% for subthreshold PTSD. Both full and subthreshold PTSD were associated with increased odds of sleep disorder (adjusted odds ratio [AOR] = 3.52 and 2.10, respectively) and respiratory conditions (AOR = 2.60 and 1.87, respectively). Full PTSD was additionally associated with increased odds of osteoporosis or osteopenia (AOR = 2.72) and migraine (AOR = 1.91), while subthreshold PTSD only was associated with increased odds of diabetes (AOR = 1.42). Analyses of PTSD symptom clusters revealed that all of these associations were primarily driven by dysphoric arousal symptoms, which are characterized by sleep difficulties, anger/irritability, and concentration problems. Limitations: The study used self-report measures for health conditions and DSM-IV diagnostic criteria for PTSD. Conclusion: Results of this study provide a characterization of physical conditions associated with full and subthreshold PTSD in U.S. military veterans. They highlight the potential importance of PTSD dysphoric arousal in risk models of certain physical conditions in this population.

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Section: Discussionmentioning

confidence: 99%

Physical health conditions associated with full and subthreshold PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study

El‐Gabalawy

Blaney

Tsai

et al. 2018

Journal of Affective Disorders

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“…A total of 9 articles underwent full-length review. Data were extracted from 7 studies (6, 8, 12-16) involving 113,558 participants. Three studies had cohort and cross-sectional designs, and one study had case-control design.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies (6, 8, 12) were included in the meta-analysis of incidence or prevalence of osteoporosis (Figure 2). The analysis revealed that odds of osteoporosis were higher in participants with OSA compared with controls among cohort studies (6, 12) with pooled OR of 1.92 (95% confidence interval [CI]: 1.24 - 2.97).…”

Section: Resultsmentioning

confidence: 99%

Association Between Obstructive Sleep Apnea and Osteoporosis: A Systematic Review and Meta-Analysis

Upala

Sanguankeo

Congrete

2016

Int J Endocrinol Metab

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ContextHypoxia reduces osteoblast growth resulting in bone thinning and osteoporosis. Although obstructive sleep apnea (OSA) with recurrent hypoxia might be a contributing factor for osteoporosis development, whether OSA is a risk or protective factor for osteoporosis has not been demonstrated.ObjectivesThis systematic review and meta-analysis evaluated the association between OSA and osteoporosis using published observational studies.Data SourcesPubMed/MEDLINE and EMBASE databasesStudy SelectionWe completed a systematic review and meta-analysis of published observational studies that evaluated incidence or prevalence of osteoporosis or bone mineral density in obstructive sleep apnea compared with controls. Severity of OSA was characterized using the apnea-hypopnea index (AHI).Data ExtractionPrimary outcomes were incidence, prevalence, or odds ratio of having osteoporosis, defined as bone mineral density T-score < -2.5 SD.ResultsOf 353 articles, 344 articles were excluded, 9 underwent full-length review and data were extracted from 7 studies consisting of 113,558 patients. Finally, 3 extracted studies were included in the meta-analysis of osteoporosis. Among cohort studies, the pooled odds ratio of osteoporosis in patients with OSA was 1.92 (95% confidence interval [CI]: 1.24 - 2.97) compared with controls. Among cross-sectional studies, odds of osteoporosis was higher in controls compared with patients with OSA (OR = 0.60, 95% CI: 0.42 - 0.87). In subgroup analysis by gender and study design, in both sexes, only cohort studies had higher odds of osteoporosis compared with controls.ConclusionsThere was significant association between OSA and osteoporosis in studies with cohort design. Further prospective studies with large numbers of patients adjusted for the effects of age, sex, or BMI are required to comprehensively determine whether OSA is a risk factor for osteoporosis.

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“…The studies included participants of variable age, an important predictor of bone density. Two studies included middle-age and young adults, age < 65 years, 3,4,7 while the other studies included older individuals, > 65 years. 2,5 Furthermore, comorbidities known to affect the skeletal system, such as diabetes and COPD, were variably included, and sometimes were not evenly distributed between participants with and without OSA.…”

mentioning

confidence: 99%

“…The defi nition of OSA and osteoporosis was based on polysomnography and DXA scan, respectively, in 3 studies, 2,5,7 while it was based on ICD codes in two studies. 3,4 Indeed, all these differences result in a high heterogeneity, as translated in a high heterogeneity index (I 2 ) in the meta-analysis of Upala et al 1 Accordingly, pooling the results of these studies is not advised, and the conclusion from this meta-analysis should be interpreted very cautiously.…”

mentioning

confidence: 99%

Obstructive Sleep Apnea and Osteoporosis Risk

Chakhtoura

Nasrallah

Chami

2015

Journal of Clinical Sleep Medicine

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Sleep disorders increase the risk of osteoporosis: a nationwide population-based cohort study

Cited by 28 publications

References 37 publications

Physical health conditions associated with full and subthreshold PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study

Physical health conditions associated with full and subthreshold PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study

Association Between Obstructive Sleep Apnea and Osteoporosis: A Systematic Review and Meta-Analysis

Obstructive Sleep Apnea and Osteoporosis Risk

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