Does Subjective Sleep Affect Bone Mineral Density in Older People with Minimal Health Disorders? The PROOF Cohort

Abstract

Study Objectives: Clinical and epidemiological studies suggest a relation between bone mineral density (BMD) and self-assessment of sleep with an effect on bone formation and osteoporosis (OS) risk in short and long sleepers. This study explores this association in a large sample of older subjects. Methods: We examined 500 participants without insomnia complaints aged 65.7 ± 0.8 y. Each participant had a full evaluation including anthropometric measurement, clinical examination and measurements of BMD at the lumbar spine and femoral sites by dual-energy X-ray absorptiometry. The daily energy expenditure (DEE) was measured by the Population Physical Activity Questionnaire. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index. The subjects were stratified into three groups according to sleep duration, i.e., short (< 6 h), normal (6-8 h), and long (≥ 8 h) sleepers. Results: Osteopenia was found in 40% of the subjects at the femoral level and 43% at the vertebral level. The prevalence of OS was lower both at femoral (8%) and vertebral (12%) levels. Short, normal, and long sleepers accounted for 29%, 40%, and 31% of subjects, respectively. After adjustments for metabolic, anthropometric, and DEE, multinomial logistic regression analysis indicated that long sleepers were more likely to have femoral neck OS with a slight effect of DEE at vertebral spine. Conclusions: In a sample of older subjects, self-reported long sleep was the best predictor of OS risk at the femoral level. This finding suggests an association between OS and self-reported sleep duration in older subjects. Clinical Trial Registration: NCT 00759304 and NCT 00766584 Keywords: sleep duration, sleep quality, osteoporosis, bone mineral density, older people Citation: Saint Martin M, Labeix P, Garet M, Thierry T, Barthélémy JC, Collet P, Roche F, Sforza E. Does subjective sleep affect bone mineral density in older people with minimal health disorders? The PROOF cohort.

Association between Sleep Quality and Body Composition in Sedentary Middle-Aged Adults

“…All aforementioned mechanisms could negatively influence BMD increasing the risk of developing osteoporosis. Our results agree with others studies that demonstrated that poor sleep quality could be associated with low BMD in middle-aged women [ 12 ], in young men [ 31 ], and older adults [ 32 ].…”

“…Finally, the lack of blood parameters mentioned above, does not allow for confirmation that the relationship is due to the proposed physiological mechanisms. Despite the aforementioned limitations, we measured sleep quality subjectively and objectively, which was indeed the strength of this study, since prior similar studies did not objectively measure sleep quality [ 12 , 13 , 14 , 31 , 32 , 46 ].…”

Sleep duration and bone health measures in older men

“…The current literature on the association between selfreported sleep duration and BMD in men is mixed. Some studies found that both long [16,[25][26][27]30] and short [12,15,16,20,23] sleep duration are associated with low BMD; however, some studies did not show any association [11,13,29]. The lack of a significant association between BMD and sleep duration in older men in the current study is similar to findings from three prior studies in middle-aged and older men.…”

“…Human data are limited to mostly cross-sectional studies showing no association [11,12] or that both short [13][14][15][16][17][18][19][20][21][22][23] and long [13][14][15][16][17][24][25][26][27][28][29][30] sleep durations are associated with low BMD (as reviewed in [31]). Of the 20 studies published to date on the association between sleep duration and BMD in humans [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], women comprised the majority of participants. All studies of men used subjective (self-reported) sleep duration and focused primarily on middle-aged adults when it is older men who are at highest risk of bone loss and fracture, and potential effect modifiers, such as vitamin D status, were not considered.…”

Sleep onset latency is related with reduced bone mineral density in elderly people with insomnia: a retrospective study

“…For example, in PROOF Cohort research of 500 participants aged 65.7±0.8 years, participants with OP at the femoral level had a greater self-reported sleep duration ( P =0.03) and were more frequently long sleepers ( P =0.004) without differences for sleep quality ( P =0.34) and sleep efficiency ( P =0.80) 15. Similarly, Tian et al reported that self-reported habitual sleep duration of 9 hours or longer was associated with an increased prevalence of OP 16.…”