Abstract
Sleep duration may be associated with risk of osteoporosis, with suggestions that too little or indeed too much sleep may be detrimental to bone health. In this study, we considered whether perceived sleep quality is also associated with bone health in older adults. We explored this association in a cohort of 443 older community-dwelling UK adults. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI); poor sleep quality was defined as > 5 on this score system. Bone density, shape and microarchitecture were assessed using dual energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT) and high-resolution pQCT (HRpQCT). Thirty-seven percent of men and 43% of women had a PSQI score greater than 5, indicative of poor perceived sleep. We found that quality of sleep was associated with altered bone microarchitecture. In men, poor sleep quality was associated with lower radial trabecular (4% slice, p < 0.04) and cortical (66% slice, p = 0.02) bone mineral density, as well as decreased tibial cortical density (p < 0.02) and increased porosity (p < 0.04), but increased size of the tibia (p < 0.04). In women, poor perceived sleep quality was associated with thinner (p < 0.03) and less dense (p < 0.04) cortices of the radius, but greater tibial trabecular number (p < 0.02) and lower separation (p < 0.04). Relationships with DXA parameters were non-significant after adjustment for confounders. Taking sleep medications was associated with decreased tibial size (38% and 66% slices) and strength in women (all p < 0.05), but not in men. Perceived sleep quality was associated with altered bone density and microarchitecture in older adults, and these differences varied according to biological sex and site. Further work is indicated to investigate possible mechanisms underlying these observations.
Highlights
Sleep quality represents a fundamental aspect of optimal health and functioning [1]
We found associations between Pittsburgh Sleep Quality Index (PSQI) score > 5 and high-resolution pQCT (HRpQCT) outcomes in men: in particular, poor sleep was associated with lower radial trabecular thickness (β − 0.41 z-score, 95% confidence intervals (CI) − 0.75, − 0.06, p < 0.03), higher tibial trabecular area (β 0.37 z-score, 95% CI 0.05, 0.69, p < 0.03) and lower tibial cortical bone mineral density (cBMD) (β − 0.35 z-score, 95% CI − 0.67, − 0.04, p = 0.03) and apparent cortical thickness (β − 0.34 z-score, 95% CI − 0.66, -0.02, p < 0.04)
We found that quality of sleep was associated with altered bone parameters in a cohort of older community-dwelling adults in the UK
Summary
Sleep quality represents a fundamental aspect of optimal health and functioning [1]. It has been theorised that sleep duration may be associated with risk of osteoporosis, with previous studies suggesting that insufficient or excessive sleep might affect bone health in middle-aged and elderly adults [5]. Previous studies have focussed mostly on short sleep duration [5,6,7,8,9,10]. We sought to explore, in a cohort of community-dwelling older adults in the UK, whether perceived sleep quality was associated with bone health and microarchitecture, and whether the relationships were the same in men and women Obstructive sleep apnoea [11,12,13,14,15,16] as possible contributors to osteoporosis.
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