Analysis Of Correlation And Influencing Factors Between OSAS And Osteoporosis

Objective:Patients with obstructive sleep apnea syndrome（OSAS）with prolonged intermittent and recurrent hypoxia can disrupt bone metabolic balance and increase the risk of osteoporosis.Therefore,the correlation and influencing factors were analyzed.Study 1 we analyzed the changes of bone density and bone metabolism in OSAS patients to explore its correlation with osteoporosis.Study 2 through the follow-up of elderly patients with OSAS,the risk and influencing factors of osteoporosis were discussed,in order to provide a basis for the early prevention of osteoporosis.Methods:Convenient sampling was adopted.In the first study,141 personnel from the Physical Examination Center of the Chinese General Hospital of the People’s Liberation Army were collected from September 2019～September 2022 as the research subjects,and the general data,body composition,sleep parameters,laboratory tests,bone density and other indicators of the research subjects were collected.According to the apnea hypopnea index（AHI）,it was divided into two groups:non-OSAS group AHI<5（n=51）;OSAS group（AHI≥5,n=90）.The t-test was used to compare the differences between the two groups,and Pearson and Spearman were used to analyze the correlation with bone density,and multiple linear regression analysis was further performed on the related indicators.In the second study,1290 elderly patients with OSAS who received nocturnal polysomnography and were diagnosed with nocturnal polysomnography were recruited from January 2015～October 2017 in the sleep medicine centers/departments of the Chinese General Hospital of the People’s Liberation Army,Peking University International Hospital,Peking University People’s Hospital,Beijing Chaoyang Hospital,the 960th Hospital of the People’s Liberation Army and the Affiliated Hospital of Gansu University of Chinese Medicine.The median follow-up was 55 months,and patients were divided into osteoporosis risk and control groups based on follow-up outcomes.Cox risk regression was used to analyze the risk factors of osteoporosis in elderly patients with OSAS.Results:Study:Correlation analysis between OSAS and osteoporosis（1）Comparison between the OSAS group and the non-OSAS group,the two groups were gender,weight,body mass index（BMI）,waist circumference,hip circumference,muscle mass,body fat mass,protein,inorganic matter,intracellular fluid,extracellular fluid,body balance（right arm）,body balance（left arm）,body balance（trunk）,body balance（right leg）,body balance（left leg）,liver disease,AHI,oxygen desaturation index（ODI）,the duration of time with Sa O₂<90%（TSA90）,percentage of the times for Sa O₂<90%in total monitoring time（T90）,mean oxygen saturation（MSp O₂）,lowest oxygen saturation（LSp O₂）,25-hydroxy vitamin D3（25-OH-D3）,high-density lipoprotein（HDL）,triglycerides（TG）,creatinine（Cr）and uric acid（UA）,the difference was statistically significant（P<0.05）.（2）There were statistically significant differences in lumbar L1-4,left and right femoral neck bone mineral density（BMD）between non-OSAS group and OSAS group with different disease degrees（P<0.05）.After further pair comparison,lumbar L1-4BMD was statistically significant between non-OSAS group and moderate and severe OSAS group（P<0.05）.The BMD of left and right femoral neck were compared between non-OSAS group and mild,moderate and severe OSAS group,and the differences were statistically significant（P<0.05）.There was no significant difference in the prevalence of osteoporosis between the non-OSAS group and mild,moderate and severe OSAS group（P>0.05）.（3）Linear regression analysis showed that BMD of L1-4 in lumbar spine was correlated with BMI,waist circumference,body fat mass,AHI,ODI,TSA90,T90,MSp O₂,LSp O₂,HDL and UA（P<0.05）.Left femoral neck BMD was associated with BMI,waist circumference,hip circumference,muscle mass,body fat mass,inorganic matter,intracellular fluid,extracellular fluid,body balance（left arm）,body balance（trunk）,body balance（right leg）,body balance（left leg）,basal metabolism,AHI,ODI,TSA90,T90,MSp O₂,LSp O₂,HDL and UA（P<0.05）.Right femoral neck bone mineral density was associated with BMI,waist circumference,hip circumference,muscle mass,body fat mass,protein,inorganic,intracellular fluid,extracellular fluid,body balance（right arm）,body balance（left arm）,body balance（trunk）,body balance（right leg）,body balance（left leg）,basal metabolism,AHI,ODI,TSA90,T90,MSp O₂,LSp O₂,HDL and UA（P<0.05）.（4）The results of multiple linear regression analysis showed that LSp O₂ was an important predictor of BMD in lumbar spine L1-4 in OSAS patients（lumbar spine L1-4 BMD=-9.743+0.124*LSp O₂）.LSp O₂,AHI and HDL were important predictors of left femoral neck BMD（left femoral neck BMD=-5.204+0.057*LSp O₂-0.017*AHI+0.873*HDL）.LSp O₂,UA and AHI were important predictors of right femoral neck BMD（right femoral neck BMD=-6.274+0.097*LSp O₂-0.015*AHI-0.003*UA）.Part Ⅱ:Risk and risk factors of osteoporosis in OSAS patients（1）A total of 1033 patients with OSAS were included in the study,430 of whom were at risk for osteoporosis.Compared with the control group,the osteoporosis risk group was older,taller,higher systolic blood pressure,smaller waist circumference,more smoking and alcohol consumption,and lower MSp O₂.In laboratory tests,TG,Cr and platelet counts were higher than those in the control group,while eosinophil absolute values,red blood cell counts and hemoglobin were lower than those in the control group（P<0.05）.In addition,carotid atherosclerosis,diabetes,coronary heart disease,cerebrovascular disease,chronic obstructive pulmonary disease,gastroesophageal reflux,and peptic ulcer were higher in patients at risk for osteoporosis（P<0.05）.（2）The number of people at risk of osteoporosis increased with the severity of OSAS,but there were no significant differences among the three groups.The risk rate of osteoporosis in males was higher than that in females（48.5%in males and 31.2%in females）,the difference was statistically significant（P<0.001）.In addition,the risk of osteoporosis mainly concentrated in 75～96 years old（P<0.001）.（3）The results of Cox analysis showed that sex（HR=1.295,95%CI:1.016-1.649）,age（HR=1.034,95%CI:1.019-1.049）,waist circumference（HR=0.985,95%CI:0.979-0.991）,MSp O₂（HR=0.965,95%CI:0.934-0.997）,carotid atherosclerosis（HR=1.686,95%CI:1.288-2.208）,diabetes（HR=1.385,95%CI:1.102-1.741）,peptic ulcer（HR=2.015,95%CI:1.042-3.895）were independently associated with osteoporosis risk in patients with OSAS.Conclusion:（1）OSAS was associated with osteoporosis.With the increase of the severity of OSAS,bone density gradually decreased.The sleep parameters LSp O₂ and AHI were important predictors of BMD reduction.（2）OSAS promoted the occurrence of osteoporosis,and age,sex,waist circumference,MSp O₂,carotid atherosclerosis,diabetes and peptic ulcer were key influencing factors.（3）OSAS patients were prone to secondary osteoporosis,and hypoxemia was an important risk factor for osteoporosis in OSAS patients.