Abstract
Summary
This population-based cross-sectional study in an older Chinese population shows a link between sleep duration, sleep timing, and osteoporosis risk, suggesting that sleep may have a role in osteoporosis development. These findings may help to identify contributing mechanisms and provide new opportunities for sleep-focused interventions to prevent osteoporosis.
Introduction
Accumulated evidence suggests that sleep pattern disruption may lead to alterations in physiology, potentially triggering the development of osteoporosis. The present study sought to examine whether sleep duration or sleep timing is associated with osteoporosis.
Methods
A total of 31,769 participants (aged 45–86 years) were recruited from the Dongfeng–Tongji cohort study. All participants completed questionnaires and medical examinations and provided blood samples. The presence of osteoporosis was determined using calcaneal quantitative ultrasonography. Logistic regression models were used to evaluate the association of sleep duration and timing with osteoporosis, after adjusting for potential confounders.
Results
The prevalence of osteoporosis was 14.2 % in men and 23.9 % in women. After controlling for potential confounders, the adjusted odds ratio (OR) [95 % confidence interval (CI)] for osteoporosis comparing sleep duration of 9 h or longer with the reference (7–8 h) was 1.40 (1.22–1.62) in men and 1.20 (1.07–1.33) in women. Men with early sleep timing (going to sleep before 21:00 h) were more likely to have osteoporosis (OR, 1.43; 95 % CI, 1.16–1.78) than those with normal sleep timing (going to sleep between 21:00 and 23:00 h). In the interaction analysis, participants with long sleep duration and early sleep timing had the highest risk of osteoporosis both in men (OR, 1.79; 95 % CI, 1.48–2.16) and women (OR, 1.41; 95 % CI, 1.19–1.66).
Conclusions
Long sleep duration (≥9 h) and early sleep timing were independently and interactively associated with an increased risk of osteoporosis in this older Chinese population.
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References
Van Cauter E, Spiegel K, Tasali E, Leproult R (2008) Metabolic consequences of sleep and sleep loss. Sleep Med 9(Suppl 1):S23–28
Ferrara M, De Gennaro L (2001) How much sleep do we need? Sleep Med Rev 5:155–179
Bonnet MH, Arand DL (1995) We are chronically sleep deprived. Sleep 18:908–911
Kobayashi D, Takahashi O, Deshpande GA, Shimbo T, Fukui T (2012) Association between osteoporosis and sleep duration in healthy middle-aged and elderly adults: a large-scale, cross-sectional study in Japan. Sleep Breath 16:579–583
Taheri S, Lin L, Austin D, Young T, Mignot E (2004) Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 3:210–217
Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S et al (2005) Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med 165:863–867
Magee CA, Kritharides L, Attia J, McElduff P, Banks E (2012) Short and long sleep duration are associated with prevalent cardiovascular disease in Australian adults. J Sleep Res 21:441–447
Cappuccio FP, D’Elia L, Strazzullo P, Miller MA (2010) Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep 33:585–592
Olds TS, Maher CA, Matricciani L (2011) Sleep duration or bedtime? Exploring the relationship between sleep habits and weight status and activity patterns. Sleep 34:1299–1307
Roenneberg T, Kuehnle T, Juda M, Kantermann T, Allebrandt K et al (2007) Epidemiology of the human circadian clock. Sleep Med Rev 11:429–438
Baron KG, Reid KJ, Kern AS, Zee PC (2011) Role of sleep timing in caloric intake and BMI. Obesity (Silver Spring) 19:1374–1381
Reutrakul S, Hood MM, Crowley SJ, Morgan MK, Teodori M et al (2013) Chronotype is independently associated with glycemic control in type 2 diabetes. Diabetes care 36:2523–2529
Ruger M, Scheer FA (2009) Effects of circadian disruption on the cardiometabolic system. Rev Endocr Metab Disord 10:245–260
Burge R, Dawson‐Hughes B, Solomon DH, Wong JB, King A et al (2007) Incidence and economic burden of osteoporosis‐related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475
Xia J, Zhong Y, Huang G, Chen Y, Shi H et al (2012) The relationship between insulin resistance and osteoporosis in elderly male type 2 diabetes mellitus and diabetic nephropathy. Annales D Endocrinologie 73:546–551
Zhao LJ, Liu YJ, Liu PY, Hamilton J, Recker RR et al (2007) Relationship of obesity with osteoporosis. J Clin Endocr Metab 92:1640–1646
Chen G, Chen L, Wen J, Yao J, Li L et al (2014) Associations between sleep duration, daytime nap duration, and osteoporosis vary by sex, menopause, and sleep quality. J Clin Endocrinol Metab 99:2869–2877
Fu XH, Zhao XY, Lu H, Jiang F, Ma XG et al (2011) Association between sleep duration and bone mineral density in Chinese women. Bone 49:1062–1066
Wang F, Zhu J, Yao P, Li X, He M et al (2013) Cohort profile: the Dongfeng-Tongji cohort study of retired workers. Int J Epidemiol 42:731–740
Njeh C, Boivin C, Langton C (1997) The role of ultrasound in the assessment of osteoporosis: a review. Osteoporos Int 7:7–22
Stone KL, Ewing SK, Lui LY, Ensrud KE, Ancoli-Israel S et al (2006) Self-reported sleep and nap habits and risk of falls and fractures in older women: the study of osteoporotic fractures. J Am Geriatr Soc 54:1177–1183
Patel SR, Malhotra A, Gottlieb DJ, White DP, Hu FB (2006) Correlates of long sleep duration. Sleep 29:881–889
Ohkuma T, Fujii H, Iwase M, Ogata-Kaizu S, Ide H et al (2014) U-shaped association of sleep duration with metabolic syndrome and insulin resistance in patients with type 2 diabetes: the Fukuoka Diabetes Registry. Metabolism 63:484–491
Pyykkonen AJ, Isomaa B, Pesonen AK, Eriksson JG, Groop L et al (2014) Sleep duration and insulin resistance in individuals without type 2 diabetes: the PPP-Botnia Study. Ann Med 46:324–329
Javaheri S, Storfer-Isser A, Rosen CL, Redline S (2011) Association of short and long sleep durations with insulin sensitivity in adolescents. J Pediatr 158:617–623
Patel SR, Malhotra A, White DP, Gottlieb DJ, Hu FB (2006) Association between reduced sleep and weight gain in women. Am J Epidemio 164:947–954
Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR (2002) Mortality associated with sleep duration and insomnia. Arch General Psychiat 59:131–136
Greendale GA, Barrett-Connor E, Edelstein S, Ingles S, Haile R (1995) Lifetime leisure exercise and osteoporosis the Rancho Bemardo Study. Am J Epidemio 141:951–959
Karlsson MK, Rosengren BE (2012) Physical activity as a strategy to reduce the risk of osteoporosis and fragility fractures. Int J Endocrinol Metab 10:527–536
Ohlsson C, B-Ak B, Isaksson OG, Andreassen TT, Slootweg MC (1998) Growth hormone and bone. Endocr Rev 19:55–79
Van Cauter E, Plat L (1996) Physiology of growth hormone secretion during sleep. J Pediatr 128:S32–37
Milligan B, Samuelsson LB, Kline CE, Frank E, Hall M (2014) Sex differences in sensitivity to the timing and regularity of sleep-wake behaviors: Sleep. Conference: 28th Annual Meeting of the Associated Professional Sleep Societies, LLC, SLEEP 2014 Minneapolis, MN United States
Duffy JF, Cain SW, Chang AM, Phillips AJ, Munch MY et al (2011) Sex difference in the near-24-hour intrinsic period of the human circadian timing system. Proc Natl Acad Sci U S A 108(Suppl 3):15602–15608
Shadan FF (2008) Sleep-wake cycle, aging and cancer. J Appl Biomed 6:131–138
Leproult R, Van Cauter E (2010) Role of sleep and sleep loss in hormonal release and metabolism. Endocr Dev 17:11–21
Gennari L, Merlotti D, Martini G, Gonnelli S, Franci B et al (2003) Longitudinal association between sex hormone levels, bone loss, and bone turnover in elderly men. Journal Clin Endocr Metab 88:5327–5333
Patel SR, Hayes AL, Blackwell T, Evans D, Ancoli-Israel S et al (2014) The association between sleep patterns and obesity in older adults. Int J Obesity 38:1159–1164
Marshall NS, Glozier N, Grunstein RR (2008) Is sleep duration related to obesity? A critical review of the epidemiological evidence. Sleep Med Rev 12:289–298
Acknowledgements
This research was supported by the National Natural Science Foundation of China (81273083), the Fundamental Research Funds for the Central Universities (2014TS051), the 111 Project, the Program for Changjiang Scholars, the Innovative Research Team in University, the China Medical Board 12-113. We thank the Dongfeng–Tongji Cohort participants and the staff at DMC in Dongfeng General Hospital for the data collection.
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Tian, Y., Shen, L., Wu, J. et al. Sleep duration and timing in relation to osteoporosis in an elderly Chinese population: a cross-sectional analysis in the Dongfeng–Tongji cohort study. Osteoporos Int 26, 2641–2648 (2015). https://doi.org/10.1007/s00198-015-3172-4
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DOI: https://doi.org/10.1007/s00198-015-3172-4