Key result
In patients with type 2 diabetes, more severe obstructive sleep apnea was significantly associated with a lower trabecular bone score in men (p=0.034) but a higher score in postmenopausal women (p=0.003).
Why the study?
Type 2 diabetes mellitus and obstructive sleep apnea may adversely affect bone, and gender influences bone health, but the impact of obstructive sleep apnea on bone mineral density and trabecular bone score in type 2 diabetes was unclear.
Does obstructive sleep apnea severity affect bone mineral density and trabecular bone score differently in men and women with type 2 diabetes?
Cross-Sectional (n=81)
Does obstructive sleep apnea severity affect bone mineral density and trabecular bone score differently in men and women with type 2 diabetes?
In patients with type 2 diabetes, severe obstructive sleep apnea is associated with worse trabecular bone score in men but paradoxically better scores in postmenopausal women.
Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) may adversely affect bone. Gender is a well-established factor influencing bone health. We investigated the impact of OSA on bone mineral density (BMD) and trabecular bone score (TBS) in T2DM. Eighty-one T2DM patients [33 men and 48 women] participated. OSA was diagnosed using an overnight monitor, with its severity assessed by an apnea hypopnia index (pAHI). The measurements of hypoxia, including the percentage of total sleep time in which oxygen saturation remains below 90% (pT90), the oxygen desaturation index (pODI) and minimum O2 (min O2), were reported. Lumbar spine (L1-4) and femoral neck (FN) BMD were measured using dual-energy X-ray absorptiometry (DXA). TBS was computed from DXA images. Sixty-five patients (80.2%) had OSA. pAHI, pT90, pODI and min O2 were not correlated to L1-4 BMD, FN BMD or TBS in all participants by multiple regression analyses adjusting for age, gender and BMI. However, an interaction between gender and pAHI, and gender and pODI were significantly associated with TBS (b = 0.003, p = 0.034 and b = 0.004, p = 0.046, respectively). We therefore reassessed an association between pAHI or pODI and TBS separately between men and women. After adjusting for age and BMI, more severe OSA (higher pAHI) and higher pODI significantly associated with lower TBS (b = −0.002, p = 0.034 and b = −0.003, p = 0.021, respectively) in men. On the other hand, higher pAHI non-significantly associated with better trabecular microarchitecture as indicated by higher TBS (b = 0.002, p = 0.059) in women. When considered only postmenopausal (n = 33), higher pAHI and higher pODI were significantly associated with higher TBS (b = 0.004, p = 0.003 and b = 0.004, p = 0.008, respectively). In T2DM patients, there is a complex interrelationship among OSA severity, gender and TBS. More severe OSA predicted lower TBS in men, but predicted higher TBS in postmenopausal women.
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Nimitphong et al. (2019) conducted a cross-sectional in Type 2 diabetes mellitus and obstructive sleep apnea (n=81). Obstructive sleep apnea severity vs. Lower severity or absence of obstructive sleep apnea was evaluated on Trabecular bone score (TBS) (b = -0.002 (men); b = 0.004 (postmenopausal women), p=0.034 (men); 0.003 (postmenopausal women)). In patients with type 2 diabetes, more severe obstructive sleep apnea was significantly associated with a lower trabecular bone score in men (p=0.034) but a higher score in postmenopausal women (p=0.003).
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