Association between sleep apnea and low bone mass in adults: a systematic review and meta-analysis

Eimar, Hazem; Saltaji, Humam; Ghorashi, Seyyed Mojtaba; Isfeld, Darren; MacLean, Joanna E.; Gozal, David; Graf, Daniel; Flores-Mir, Carlos

doi:10.1007/s00198-017-3912-8

Cited by 29 publications

(15 citation statements)

References 58 publications

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“…When appraising the association between the severity of OSA (represented by the AHI) and bone density (represented by bone density [g/cm 2 ] or T-score) in adults, inconsistent findings have been reported. On the one hand, the severity of OSA was negatively associated with bone density (Eimar et al 2017), whereas on the other hand, a positive association between the severity of OSA and bone density was reported (Sforza et al 2013). Also, other investigators have reported no significant associations between the severity of OSA and bone density (Mariani et al 2012).…”

Section: Discussionmentioning

confidence: 99%

Sleep-Disordered Breathing Is Associated with Reduced Mandibular Cortical Width in Children

Eimar

Al-Saleh

Cortes

et al. 2018

JDR Clinical & Translational Research

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Introduction: Evidence from the adult population suggests that sleep-disordered breathing (SDB) (i.e., obstructive sleep apnea [OSA]) is negatively associated with bone mineral density. Whether a similar association exists in children with SDB has not been investigated. Using the mandibular cortical width (MCW) as a proxy for skeletal bone density, we investigated if children at risk of SDB or diagnosed with OSA have a reduced mandibular cortical width compared to children without SDB. Methods: Two retrospective crosssectional studies were performed. The first study included comparison of MCW between 24 children with polysomnographically (PSG) diagnosed OSA and 72 age-and sex-matched control children. The second study included a cohort of children in which SDB was suggested by the Pediatric Sleep Questionnaire (PSQ) (n = 101). MCW was measured from panoramic radiographs. Results: Multiple-predictors regression analysis from the first study indicated that in children with a severe form of SDB, as induced by OSA severity, there was a negative association with MCW (β =-0.290, P = 0.049). Moreover, PSG-diagnosed OSA children had thinner MCW (2.9. ± 0.6mm) compared to healthy children (3.5 ± 0.6 mm; P = 0.002). These findings were further supported by the second study illustrating that PSQ total scores were negatively associated with MCW (β =-0.391, P < 0.001). Conclusions: Findings suggest that children at risk for or diagnosed with SDB exhibit reduced mandibular cortical width that purportedly may reflect alterations in bone homeostasis. Knowledge Transfer Statement: We report that sleep-disordered breathing (including its severe form, obstructive sleep apnea) in children is associated with reduced mandibular cortical width. This association might be a direct consequence of reduced bone health to sleep-disordered breathing or a reflection that reduced bone formation underlies the development of sleep-disordered breathing. Our findings suggest that mandibular cortical width can be used as an adjunct diagnostic parameter for the diagnosis of sleep-disordered breathing.

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Section: Discussionmentioning

confidence: 99%

Sleep-Disordered Breathing Is Associated with Reduced Mandibular Cortical Width in Children

Eimar

Al-Saleh

Cortes

et al. 2018

JDR Clinical & Translational Research

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“…Apneic episodes cause hypoxia, which in turn leads to metabolic changes that are harmful to bones [5]. A number of researchers have reported an association between sleep apnea and low bone mass, but the supporting evidence is subject to debate [10, 11]. Osteoporosis and vertebral fractures, on the other hand, have been linked to increased prevalence of OSA as a secondary consequence [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Is sleep apnea underdiagnosed in adult patients with osteogenesis imperfecta? –a single-center cross-sectional study

Arponen

Bachour

Bäck

et al. 2018

Orphanet J Rare Dis

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BackgroundPatients with Osteogenesis imperfecta (OI) suffer from increased bone fracture tendency generally caused by a mutation in genes coding for type I collagen. OI is also characterized by numerous co-morbidities, and recent data from questionnaire studies suggest that these may include increased risk for sleep apnea, a finding that lacks clinical evidence from cohort studies. In this cross-sectional study, 25 adults with OI underwent clinical otorhinolaryngology examination as well as overnight polysomnography to address the question. The participants were aged between 19 and 77 years, and ten of them had mild clinical OI phenotype, seven had a moderately severe phenotype, and eight had a severe phenotype.ResultsWe found obstructive sleep apnea (apnea hypopnea index ≥5/h) in as many as 52% of the OI patients in the cohort. Unexpectedly, however, no correlation was present between sleep apnea and daytime sleepiness, experienced bodily pain, severity of OI, Mallampati score, or neck circumference.ConclusionsSeeing that the usual predictors showed no association with occurrence of sleep apnea, we conclude that obstructive sleep apnea may easily be left as an undetected disorder in individuals with OI. Recurrent nocturnal hypoxia due to episodes of apneas can even affect bone metabolism, thereby further aggravating bone fragility in patients with OI.

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“…Recently, increasing evidence has suggested that sleep characteristics, including sleep apnea and nighttime and daytime sleep duration, are related to osteoporosis. Some studies have demonstrated an association between more severe sleep apnea and increased risk of osteoporosis 3 , 4 . Others have examined the relationship between nighttime sleep duration and bone health.…”

Section: Introductionmentioning

confidence: 99%

The Association between Daytime Napping Characteristics and Bone Mineral Density in Elderly Thai Women without Osteoporosis

Saetung

Reutrakul

Chailurkit

et al. 2018

Sci Rep

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Low bone mass is more prevalent with increasing age. Studies have found associations between sleep duration, sleep quality and obstructive sleep apnea and bone mineral density (BMD). However, less is known about the relationship between daytime napping and BMD. We aimed to investigate the association between daytime napping and BMD in elderly Thai women. Demographic data, lifestyle information and sleep characteristics were obtained by interviewing 387 elderly women. Weight and height were measured. Serum 25-hydroxyvitamin D [25(OH)D] was measured by radioimmunoassay. BMD was measured by dual-energy X-ray absorptiometry (DXA). Higher BMI and having type 2 diabetes (T2DM) were correlated with higher lumbar spine 2–4 (L2-4) BMD, while younger age, higher BMI and higher serum 25(OH)D level were correlated with higher femoral neck (FN) and total hip (TH) BMD. After adjusting for age, age at menopause, BMI, 25(OH)D level and T2DM, a higher frequency of weekly daytime napping was associated with lower FN and TH BMD but not at L2-4 BMD. Additionally, longer daytime napping duration was negatively associated with BMD at TH. In summary higher frequency and longer duration of daytime napping are associated with lower femoral BMD in elderly women. Mechanisms underlying these associations should be further explored.

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Association between sleep apnea and low bone mass in adults: a systematic review and meta-analysis

Abstract: An association between sleep apnea and low bone mass in adults is plausible, but supporting evidence has a risk of bias and is inconsistent.

Cited by 29 publications

References 58 publications

Sleep-Disordered Breathing Is Associated with Reduced Mandibular Cortical Width in Children

Sleep-Disordered Breathing Is Associated with Reduced Mandibular Cortical Width in Children

Is sleep apnea underdiagnosed in adult patients with osteogenesis imperfecta? –a single-center cross-sectional study

The Association between Daytime Napping Characteristics and Bone Mineral Density in Elderly Thai Women without Osteoporosis

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