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Effect of Obstructive Sleep Apnea on Bone Mineral Density
Shadan Sadaf1, Mohammad Shameem1, Sheelu Shafiq Siddiqi2
1Department of Respiratory Medicine, Jawahar Lal Nehru Medical College, Aligarh Muslim University, Uttar Pradesh, India.
Turkish Thoracic Journal
|February 3, 2022
Summary
Obstructive sleep apnea (OSA) is linked to lower bone mineral density (BMD) due to factors like hypoxia and disturbed sleep. Increased apnea-hypopnea index (AHI) severity directly correlates with reduced BMD and lower vitamin D levels.
Area of Science:
- Bone Metabolism and Sleep Science
Background:
- Obstructive sleep apnea (OSA) is increasingly recognized for its impact on systemic health, including bone metabolism.
- Hypoxia, respiratory acidosis, oxidative stress, and disrupted circadian rhythms (affecting leptin and melatonin) are key pathophysiological factors in OSA that can influence bone resorption.
- Comorbidities like vitamin D deficiency, hypogonadism, obesity, and insulin resistance associated with OSA may also indirectly affect bone mineral density (BMD).
Purpose of the Study:
- To investigate the relationship between obstructive sleep apnea (OSA) and bone mineral density (BMD).
- To explore the correlation between the severity of OSA, indicated by the apnea-hypopnea index (AHI), and BMD.
- To assess vitamin D levels in patients with OSA compared to controls.
Main Methods:
- A prospective case-control study involving screening for sleep-related breathing disorders using the STOPBANG questionnaire.
- Participants with a STOPBANG score >2 underwent polysomnography (PSG) to determine the apnea-hypopnea index (AHI).
- Cases were defined as AHI > 5, controls as AHI < 5. Both groups underwent DEXA scans for BMD and serum vitamin D level assessment.
Main Results:
- The study included 59 OSA cases and 34 controls. The OSA group exhibited significantly lower mean BMD compared to the non-OSA control group (Z-score: -2.02 vs. -1.03; P < .001).
- A significant negative correlation was found between the apnea-hypopnea index (AHI) and BMD (r = -0.507, P < .001), indicating lower BMD with increased OSA severity.
- Mean vitamin D levels were lower in the OSA group (21.02 ± 7.27) compared to controls (24.48 ± 6.92, P < .05), with a negative correlation between AHI and serum vitamin D (P < .001, r = -0.286).
Conclusions:
- Obstructive sleep apnea (OSA) negatively impacts bone mineral density (BMD) through various pathophysiological mechanisms.
- The apnea-hypopnea index (AHI) is inversely correlated with BMD, meaning greater OSA severity is associated with lower BMD.
- Lower vitamin D levels in OSA patients may contribute to reduced BMD.
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