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

Xin-Yuan Wang; Xin-Yu Wang; Zhi-Xin Liao; Yue-An Zhao; Chang Wei; Lin-Jing Gong

doi:10.1007/s41105-023-00481-1

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

Sleep Biol Rhythms. 2023 Aug 10;22(1):65-73. doi: 10.1007/s41105-023-00481-1. eCollection 2024 Jan.

Authors

Xin-Yuan Wang^#¹, Xin-Yu Wang^#², Zhi-Xin Liao¹, Yue-An Zhao², Chang Wei², Lin-Jing Gong²

Affiliations

¹ Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041 Sichuan China.
² Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041 Sichuan China.

^# Contributed equally.

PMID: 38476856
PMCID: PMC10899924 (available on 2024-08-10)
DOI: 10.1007/s41105-023-00481-1

Abstract

Introduction: This study aimed to synthesize existing evidence on the potential association between obstructive sleep apnea (OSA) and low bone mass in adults.

Methods: Electronic searches of four main databases were performed. The inclusion criteria consisted of observational studies investigating the relationship between OSA and bone mass, osteoporosis, fractures, or bone metabolism markers in adult population. Bone mineral density (BMD) and T score of lumbar and femur neck, incidence of osteoporosis and fractures, bone metabolism marker levels were extracted as primary outcomes.

Results: Among the 693 relevant publications, 10 studies consisting of 158,427 participants met with the inclusion and exclusion criteria. Meta-analysis showed a significant lower BMD of lumbar (mean difference (MD) = - 0.03; 95% CI - 0.05, - 0.01; I² = 46%), femur neck (MD = - 0.06; 95% CI - 0.12, 0.00; I² = 71%), and a significant lower T score of lumbar (MD = - 0.42; 95% CI - 0.79, - 0.05; I² = 63%) in the OSA group. The results suggested that both male (odds ratio (OR) = 2.03; 95% CI 1.23, 3.35; I² = 38%) and female (OR = 2.56; 95% CI 1.96, 3.34; I² = 0%) had higher risk of osteoporosis in the OSA group. Besides, meta-analysis also showed that bone-specific alkaline phosphatase was significantly lower in OSA patients (MD = - 1.90; 95% CI - 3.48, - 0.32; I² = 48%).

Conclusions: A potential association between OSA and lower bone mass in adults is preliminarily proved. It also seems plausible that both male and female with OSA have a higher risk of osteoporosis.

Supplementary information: The online version contains supplementary material available at 10.1007/s41105-023-00481-1.

Keywords: Bone density; Bone metabolism marker; Meta-analysis; Obstructive sleep apnea; Osteoporosis; Systematic review.

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