The association between obstructive sleep apnea and osteoporosis: A systematic review and meta-analysis

Yong Hoe Chan; Chong Boon Teo; Joshua K Tay; Crystal S Cheong

doi:10.1016/j.smrv.2024.102006

The association between obstructive sleep apnea and osteoporosis: A systematic review and meta-analysis

Sleep Med Rev. 2024 Sep 7:78:102006. doi: 10.1016/j.smrv.2024.102006. Online ahead of print.

Authors

Yong Hoe Chan¹, Chong Boon Teo², Joshua K Tay³, Crystal S Cheong⁴

Affiliations

¹ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
² Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
³ Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore. Electronic address: joshtay@nus.edu.sg.
⁴ Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore. Electronic address: crystal_sj_cheong@nuhs.edu.sg.

PMID: 39298877
DOI: 10.1016/j.smrv.2024.102006

Abstract

Obstructive sleep apnea (OSA) is a sleep disorder with well-known metabolic consequences. The relationship between OSA and bone health, especially osteoporosis, remains poorly understood. Given that both OSA and osteoporosis are highly prevalent chronic conditions with significant public health implications, this study aims to investigate the association of OSA with bone health and osteoporosis. A systematic search of PubMed, Embase and Cochrane Library was conducted from inception to November 22, 2022. Fifteen studies comprising 158,273 individuals were included. The presence of OSA correlated negatively with bone mineral density on meta-analysis (pooled correlation = -0.30; 95 % CI, -0.42 to -0.17; N = 8). Individuals with OSA had poorer bone mineral density scores (mean difference = -0.58, 95 % CI, -1.15 to -0.01; N = 8), and significantly higher risk of developing osteoporosis (adjusted odds ratio = 2.18; 95 % CI, 1.14 to 4.16; N = 4). Notably, both body mass index (BMI) and age were not significant effect modulators in the correlation of OSA and bone density. These findings suggest that OSA is associated with diminished bone health, and it is severity-dependent. Further studies are required to determine if treatment of OSA may have the potential to mitigate these risks.

Keywords: Bone health; Bone mineral density; Metabolic bone disease; Obstructive sleep apnea; Osteoporosis; Sleep apnea; Sleep apnea syndrome; Sleep disordered breathing.

Publication types

Review