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Sleep apnea and femoral neck BMD among Singaporean mid-life women

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Abstract

Summary

The relationship between sleep apnea and bone health remains controversial. This study explored the relationship between sleep apnea and femoral neck BMD in midlife Asian women. Partner-witnessed apnea predicted higher femoral neck BMD, an effect validated by the STOP index. Our findings suggest that sleep apnea may protect bone health.

Purpose

The menopause transition is associated with decline in bone mineral density (BMD) and sleep quality. However, any relationship between these two factors remains controversial. This study explored the association between sleep apnea and femoral neck BMD in middle-aged women.

Methods

Participants (n = 1201) aged 45–69 years attending well-women visits at the National University Hospital, Singapore were recruited. Self-reported breathing discomfort and snoring, partner-witnessed apnea and snoring were assessed from the Pittsburgh Sleep Quality Index. Femoral neck BMD was assessed with dual-energy X-ray absorptiometry scan and classified into tertiles based on T-scores. Factors reported to affect sleep apnea and bone health in medical literature were potential covariates, p < 0.10. Multivariable ordinal regression analyses assessed associations between sleep measures and BMD. To further validate our findings, we analyzed four sleep apnea characteristics from the STOP questionnaire, a screening tool for sleep apnea. All analyses were performed using SPSS version 20.0.

Results

Mean (SD) age of participants was 56.3 (6.2) years. Partner-witnessed apnea predicted higher BMD tertiles (OR per unit increase in severity 1.39, 95% CI [1.02, 1.89]), independent of age, ethnicity, diabetes, BMI, and handgrip strength. This was further corroborated by the STOP index (OR 1.45, 95% CI [1.07, 1.96]).

Conclusions

This study adds to the literature on sleep apnea and bone health in a non-Caucasian and younger population. Our findings support OSA-associated intermittent hypoxia protecting bone health.

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Acknowledgments

We would like to thank our study participants and study coordinators, Eng Sok Kheng, Chua Seok Eng, Poon Peng Cheng, Ng Poh Lian, Zhang Xuan, Teo Yean Ling, Saw Myat Sabai, and Ho Kum Chue who assisted in the data compilation. We are thankful to Low Siew Leng and Tan Sze Yee, the staff of Orthopaedic Diagnostic Centre, who conducted all the DEXA scans for our participants. We acknowledge the contribution by Dr. Stephen Smagula in conducting the pre-study workshops and advising on the study design methodologies and analysis.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, National University of Singapore, 1E, Road, Tower Block Level 12, Kent Ridge, 119228, Singapore

    Han Ying Tng, Win Pa Pa Thu, Susan Logan, Izzuddin M. Aris & Eu Leong Yong

  2. Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    Jane Cauley

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  1. Han Ying Tng
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  2. Win Pa Pa Thu
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  3. Susan Logan
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  4. Izzuddin M. Aris
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Corresponding author

Correspondence to Eu Leong Yong.

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The protocol was approved by the Domain Specific Review Board of National Healthcare Group, Singapore, and all participants provided written informed consent.

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Tng, H.Y., Thu, W.P.P., Logan, S. et al. Sleep apnea and femoral neck BMD among Singaporean mid-life women. Arch Osteoporos 13, 19 (2018). https://doi.org/10.1007/s11657-018-0428-6

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