Effect Of Obstructive Sleep Apnea Hypopnea Syndrome On Bone Metabolism In Men

Objective（s）:By measuring the ratio of serum nuclear factor k B receptor activator ligand/osteoprotegerin（RANKL/OPG）,N-terminal mid molecule fragment of osteocalcin（N-MID）,and type I collagen cross-linked carboxyl terminal peptide in adult male patients with obstructive sleep apnea hypopnea syndrome（OSAHS）(β-Exploring the effects of OSAHS on bone metabolism related indicators by examining changes in CTX levels and bone mineral density（BMD）.Methods:The study subjects were 42 male OSAHS patients,15 healthy examinees,and 17 osteoporosis patients who visited the Sleep Medicine Department,Physical Examination Center,Endocrinology Department,Orthopedics Department,and Pain Department of Yunnan First People’s Hospital from December 2021 to March 2023.According to the sleep apnea hypopnea index（AHI）and the lowest oxygen saturation（LSp O₂）,patients with OSAHS were further divided into mild and moderate OSAHS group（5 times/hour≤AHI<30 times/hour;80%≤LSp O₂<90%）of 21 cases and severe OSAHS group（AHI≥30 times/hour,LSp O₂<80%）of 21 cases.All research subjects collected general information and clinical data,underwent BMD testing,and tested for serum N-MIDβ-The content of CTX and 25-hydroxyvitamin D（25（OH）Vit D）.The OSAHS patient group and the healthy control group were monitored by polysomnography（PSG）for 7 hours all night,and venous blood was taken on an empty stomach the next day to detect the contents of RANKL and OPG.Compare the differences in general information,PSG monitoring parameters,biochemical indicators,BMD measurement values,and bone metabolism related indicators among each group,and analyze the relevant factors that affect the content of bone metabolism indicators and RANKL/OPG ratio.Results:Compared with the BMD measurements of the first to fourth lumbar vertebrae（L1-L4）,neck of femur,and hip joint,the BMD measurements of the osteoporosis group were significantly lower than those of the OSAHS group and the healthy control group（P<0.01）;Compared with the healthy control group,there was no difference in BMD measurement values among different parts of the OSAHS group（P>0.05）.The serum N-MID concentration showed a continuous decreasing trend from the healthy control group,mild to moderate OSASH group,severe OSAHS group to the osteoporosis group.There was no significant difference between the mild to moderate OSASH group and the healthy control group（P>0.05）,while the serum N-MID concentration in the severe OSAHS group was similar to that of the osteoporosis group and significantly lower than that of the healthy control group and mild to moderate OSASH group,showing statistical differences（P<0.05）.serumβ-There was no statistically significant difference in the levels of CTX and 25（OH）Vit D between the study groups（P>0.05）.The serum OPG concentration was highest in the healthy control group,followed by the mild to moderate OSAHS group,and lowest in the severe OSAHS group.The difference in serum OPG concentration between the severe OSAHS group and the first two groups was statistically significant（P<0.05）;There was no significant difference in serum RANKL concentration among the three groups（P>0.05）;The RANKL/OPG ratios of the healthy control group,mild to moderate OSAHS group,and severe OSAHS group were 0.24,0.31,and 0.42,respectively.The ratio of the severe OSAHS group was significantly higher than the other two groups,with statistical differences（P<0.01）.Spearman correlation analysis showed that N-MID concentration was negatively correlated with AHI and the percentage of time when oxygen saturation was less than 90%in the total monitoring time（ST90）（r=-0.321,r=-0.413,P<0.05）;It was positively correlated with mean oxygen saturation（MSp O₂）（r=0.411,P<0.05）;RANKL/OPG is positively correlated with AHI and ST90（r=0.340,r=0.404,P<0.05）;There is a negative correlation with MSp O₂（r=-0.324,P<0.05）.Conclusion（s）:Bone metabolism in patients with OSAHS can affect men,influence degree is mainly associated with AHI,ST90 and MSp O₂.In reflecting early bone metabolism abnormalities,changes in serum bone metabolism indicators are more sensitive than bone density testing.