Abstract
Purpose
Obstructive sleep apnea syndrome (OSAS) is a disorder that is characterized by repetitive pauses in breathing during sleep. Airway obstruction episodes can lead to ischemia or hypoxia in tissues. Hypoxia may also have an effect on bone metabolism. In this study, we aim to investigate both the bone metabolic abnormalities and bone mineral density (BMD) in OSAS patients compared to individuals without OSAS.
Methods
Twenty-one male patients with OSAS and 26 control subjects, also male, enrolled in this study. Serum calcium, phosphorus, alkaline phosphatase, and urinary desoxypiridinoline levels were measured in all participants, and BMD was evaluated using DEXA (Hologic QDR 2000). The BMD was measured in the lumbar spine (L1–L4), the femoral neck, and total femur region.
Results
No statistically significant difference was noted between the two groups with respect to demographic data, except for body mass index (BMI). We adjusted the statistical analyses in line with the BMI and noted significant differences between OSAS patients and control subjects with regard to lumbar L1–L4 t score, lumbar L1–L4 BMD, and femoral neck BMD values (p ≤ 0.001). We find significant correlations with lumbar L1-L4 BMD (r = −0.4; p = 0.023) and lumbar L1–L4 t score values (r = −0.5; p = 0.012).
Conclusion
Our study indicates that there is a relationship between OSAS and osteoporosis. However, further controlled studies comprising a greater number of patients are needed to investigate the relationship between osteoporosis and OSAS.
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References
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235
Ohisa N, Ogawa H, Murayama N, Yoshida K (2011) A novel EEG index for evaluating the sleep quality in patients with obstructive sleep apnea–hypopnea syndrome. Tohoku J Exp Med 223:285–289. doi:10.1620/tjem.223.285
Collop NA (2005) Obstructive sleep apnea syndromes. Semin Respir Crit Care Med 26:13–24. doi:10.1055/s-2005-864198
Nair D, Dayyat EA, Zhang SX, Wang Y, Gozal D (2011) Intermittent hypoxia-induced cognitive deficits are mediated by NADPH oxidase activity in a murine model of sleep apnea. PLoS One 6:e19847. doi:10.1371/journal.pone.0019847
Shamsuzzaman AS, Gersh BJ, Somers VK (2003) Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 290:1906–1914. doi:10.1001/jama.290.14.1906
Hatipoglu U, Rubinstein I (2003) Inflammation and obstructive sleep apnea syndrome pathogenesis: a working hypothesis. Respiration 70:665–671. doi:10.1159/000075218
Arnett TR, Gibbons DC, Utting JC, Orriss IR, Hoebertz A, Rosendaal M, Meghii S (2003) Hypoxia is a major stimulator of osteoclast formation and bone resorption. J Cell Physiol 196:2–8. doi:10.1002/jcp.10321
Arnett TR (2010) Acidosis, hypoxia and bone. Arch Biochem Biophys 503:103–109. doi:10.1016/j.abb.2010.07.021
Genetos DC, Toupadakis CA, Raheja LF, Wong A, Papanicolaou SE, Fyhrie DP, Loots GG, Yellowley CE (2010) Hypoxia decreases sclerostin expression and increases Wnt signaling in osteoblasts. J Cell Biochem 110:457–467. doi:10.1002/jcb.22559
Basu S, Michaëlsson K, Olofsson H, Johansson S, Melhus H (2001) Association between oxidative stress and bone mineral density. Biochem Biophys Res Commun 288:275–279. doi:10.1006/bbrc.2001.5747
Halpern R, Becker L, Iqbal SU, Kazis LE, Macarios D, Badamgarav E (2011) The association of adherence to osteoporosis therapies with fracture, all-cause medical costs, and all-cause hospitalizations: a retrospective claims analysis of female health plan enrollees with osteoporosis. J Manag Care Pharm 17:25–39
Tomiyama H, Okazaki R, Inoue D, Ochiai H, Shiina K, Takata Y, Hashimoto H, Yamashina A (2008) Link between obstructive sleep apnea and increased bone resorption in men. Osteoporos Int 19:1185–1192. doi:10.1007/s00198-007-0556-0
Masood A, Phillips B (2000) Sleep apnea. Curr Opin Pulm Med 6:479–484
Ruehland WR, Rochford PD, O’ Donoghue FJ, Pierce RJ, Singh P, Thornton AT (2009) The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep 32:150–157
Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239. doi:10.1164/rccm.2109080
McNicholas WT (2009) Obstructive sleep apnea and inflammation. Prog Cardiovasc Dis 51:392–399. doi:10.1016/j.pcad.2008.10.005
Fava C, Montagnana M, Favaloro EJ, Guidi GC, Lippi G (2011) Obstructive sleep apnea syndrome and cardiovascular diseases. Semin Thromb Hemost 37:280–297. doi:10.1055/s-0031-1273092
Malakasioti G, Alexopoulos E, Befani C, Tanou K, Varlami V, Ziogas D, Liakos P, Gourgoulianis K, Kaditis AG (2011) Oxidative stress and inflammatory markers in the exhaled breath condensate of children with OSA. Sleep Breath 2011. doi:10.1007/s11325-011-0560-7
McCord JM (2000) The evolution of free radicals and oxidative stress. Am J Med 108:652–659
McCord JM (1985) Oxygen-derived free radicals in postischemic tissue injury. N Engl J Med 312:159–163
Papaioannou A, Parkinson W, Ferko N, Probyn L, Ioannidis G, Jurriaans E, Cox G, Cook RJ, Kumbhare D, Adachi JD (2003) Prevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in Canada. Osteoporos Int 14:913–917. doi:10.1007/s00198-003-1449-5
Miller RG, Segal JB, Ashar BH, Leung S, Ahmed S, Siddique S, Rice T, Lanzkron S (2006) High prevalence and correlates of low bone mineral density in young adults with sickle cell disease. Am J Hematol 81:236–241. doi:10.1002/ajh.20541
Akeno N, Czyzyk-Krzeska MF, Gross TS, Clemens TL (2001) Hypoxia induces vascular endothelial growth factor gene transcription in human osteoblast-like cells through the hypoxia-inducible factor-2alpha. Endocrinology 142:959–962. doi:10.1210/en.142.2.959
Steinbrech DS, Mehrara BJ, Saadeh PB, Greenwald JA, Spector JA, Gittes GK, Longaker MT (2000) Hypoxia increases insulin like growth factor gene expression in rat osteoblasts. Ann Plast Surg 44:529–534
Salim A, Nacamuli RP, Morgan EF, Giaccia AJ, Longaker MT (2004) Transient changes in oxygen tension inhibit osteogenic differentiation and Runx2 expression in osteoblasts. J Biol Chem 279:40007–40016. doi:10.1074/jbc.M403715200
Orriss IR, Knight GE, Utting JC, Taylor SE, Burnstock G, Arnett TR (2009) Hypoxia stimulates vesicular ATP release from rat osteoblasts. J Cell Physiol 220:155–162. doi:10.1002/jcp.21745
Utting JC, Flanagan AM, Brandao-Burch A, Orriss IR, Arnett TR (2010) Hypoxia 9 stimulates osteoclast formation from human peripheral blood. Cell Biochem Funct 28:374–380. doi:10.1002/jcp.21745
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Uzkeser, H., Yildirim, K., Aktan, B. et al. Bone mineral density in patients with obstructive sleep apnea syndrome. Sleep Breath 17, 339–342 (2013). https://doi.org/10.1007/s11325-012-0698-y
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DOI: https://doi.org/10.1007/s11325-012-0698-y