Abstract
BackgroundStudies demonstrate an association between vitamin D (25(OH)D) deficiency and sleep disturbances, such as obstructive sleep apnea (OSA) and short sleep duration. However, to date, no studies have concurrently and objectively evaluated the effect of these factors on 25(OH)D.ObjectivesTo evaluate whether OSA and objective short sleep duration are independently associated with reduced 25(OH)D in an adult population sample.MethodsA cross-sectional study included 657 individuals from the city of Sao Paulo, Brazil, as part of the ERA project. Participants fulfilled questionnaires and underwent clinical evaluation, polysomnography and blood sample collection for 25(OH)D quantification. OSA was classified into three categories (mild, moderate and severe). The risk of 25(OH)D deficiency was considered as levels<30 ng/mL. Short sleep duration was defined as total sleep time<6 hours.ResultsThe risk of 25(OH)D deficiency was observed in 59.5% of the sample, affecting more individuals of the female gender, obese, with African American ethnicity, and those that were smokers, sedentary and presented hypertension and diabetes. In the final logistic model adjusted for age, gender, ethnicity, obesity, smoking, hypertension, diabetes, sedentary lifestyle, seasonality and creatinine serum levels, both OSA and short sleep duration showed significant independent associations with the risk of 25(OH)D deficiency (moderate OSA: OR for 25(OH)D<30 = 2.21, 95% CI: 1.35–3.64, p<0.01; severe OSA: OR for 25(OH)D<30 = 1.78, 95% CI: 1.06–3.00, p = 0.03; short sleep duration: OR for 25(OH)D<30 = 1.61, 95% CI: 1.15–2.26, p = 0.01). After a subgroup analysis, similar results were observed only in participants ≥50 years.ConclusionOSA and short sleep duration are independently associated with the risk of 25(OH)D deficiency in an adult population. Age-related changes in vitamin D metabolism and the frequency of sleep disorders may be involved in these associations. Future studies exploring whether 25(OH)D levels may modulate OSA and sleep curtailment-related outcomes are needed.
Highlights
In the final logistic model adjusted for age, gender, ethnicity, obesity, smoking, hypertension, diabetes, sedentary lifestyle, seasonality and creatinine serum levels, both obstructive sleep apnea (OSA) and short sleep duration showed significant independent associations with the risk of 25(OH)D deficiency (moderate OSA: OR for 25(OH)D
Obstructive sleep apnea (OSA) shares relevant risk factors with 25(OH)D deficit, such as age, obesity, hypertension, kidney disease[7], [8] and diabetes. [9], [10] OSA has been linked to reduced levels of 25(OH)D, as this sleep disorder leads to sleep fragmentation and daytime sleepiness, which might increase the risk of vitamin D deficiency [10,11,12]
More recently, Liguori et al have found that continuous positive airway pressure (CPAP) has an impact on the vitamin D homeostasis of male OSA patients, reinforcing a potential causal relationship in the association between OSA and lower levels of this hormone. [13], [14] Likewise, subjectively measured short sleep duration has been associated with lower 25 (OH)D levels. [15], [16] recent evidence suggested a relationship between objective short sleep duration and 25(OH)D deficit
Summary
Apart from bone homeostasis, vitamin D (25(OH)D) has been implicated in an increasing number of physiological mechanisms, including sleep. [1] Several studies have identified vitamin D receptors (VDR) in most tissues in the body, including both neuronal and glial cells in the central nervous system. [2] VDR are present in multiple areas of the human brain, including the prefrontal cortex, cingulate gyrus, thalamus, substantia nigra, hippocampus, and the hypothalamus, a brain area that regulates sleep-wake cycle among other behaviors. [2,3,4] in the last decade, studies reporting associations between sleep disorders and lower levels of 25(OH)D increased consistently. [5], [6]obstructive sleep apnea (OSA) shares relevant risk factors with 25(OH)D deficit, such as age, obesity, hypertension, kidney disease[7], [8] and diabetes. [9], [10] OSA has been linked to reduced levels of 25(OH)D, as this sleep disorder leads to sleep fragmentation and daytime sleepiness, which might increase the risk of vitamin D deficiency [10,11,12]. [9], [10] OSA has been linked to reduced levels of 25(OH)D, as this sleep disorder leads to sleep fragmentation and daytime sleepiness, which might increase the risk of vitamin D deficiency [10,11,12]. [13], [14] Likewise, subjectively measured short sleep duration has been associated with lower 25 (OH)D levels. [15], [16] recent evidence suggested a relationship between objective short sleep duration (measured by actigraphy) and 25(OH)D deficit. This study aimed to investigate whether OSA and short sleep duration measured by polysomnography (PSG) are independently associated with the risk of serum 25(OH)D deficiency in an adult sample of Sao Paulo, Brazil. To date, no studies have concurrently and objectively evaluated the effect of these factors on 25(OH)D
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