Chinese General Practice ›› 2022, Vol. 25 ›› Issue (30): 3825-3833.DOI: 10.12114/j.issn.1007-9572.2022.0104

Special Issue: 睡眠问题专题研究

• Article·Evidence-based Medicine • Previous Articles     Next Articles

Relationship between Obstructive Sleep Apnea Hypopnea Syndrome and Bone Metabolism: a Systematic Review and Meta-analysis

  

  1. 1. Shanghai JiaoTong University School of Nursing, Shanghai 200025, China
    2. Minimally Invasive Spine Surgery Center, Naval Medical University Affiliated Changzheng Hospital, Shanghai 200003, China
  • Received:2022-02-12 Revised:2022-06-08 Published:2022-10-20 Online:2022-07-21
  • Contact: Bingqian ZHU
  • About author:
    MU Y P, WEI X X, SAJIDANMU·K D E, et al. Relationship between obstructive sleep apnea hypopnea syndrome and bone metabolism: a systematic review and Meta-analysis[J]. Chinese General Practice, 2022, 25 (30) : 3825-3833. MU Yunping and WEI Xiaoxue are co-first aothors

阻塞性睡眠呼吸暂停低通气综合征与骨代谢关系的系统综述和Meta分析

  

  1. 1.200025 上海市,上海交通大学护理学院
    2.200003 上海市,上海海军军医大学附属长征医院脊柱微创中心
  • 通讯作者: 朱冰倩
  • 作者简介:
    牟云平与魏晓雪为共同第一作者 牟云平,魏晓雪,萨吉旦木·卡地尔,等.阻塞性睡眠呼吸暂停低通气综合征与骨代谢关系的系统综述和Meta分析[J].中国全科医学,2022,25(30):3825-3833.[www.chinagp.net] 作者贡献:牟云平进行研究设计和实施、文献/资料收集整理、数据提取、文章撰写与修订;魏晓雪进行研究设计和实施、文献/资料收集整理、数据提取、统计学分析及结果撰写、文章修订;萨吉旦木·卡地尔参与研究实施,进行文献/资料收集整理、数据提取;朱大乔对文章内容进行评阅、指导;石长贵对文章的知识性内容提供指导;朱冰倩进行研究设计及评阅、研究经费获取、质量控制和审校修订、对文章整体负责。
  • 基金资助:
    上海市科学技术委员会"扬帆计划"(19YF1425300); 上海市卫生健康委员会科研项目(20194Y0101)

Abstract:

Background

Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with bone metabolism in Western population. Chinese population manifest different development progress of OSAHS and bone metabolism owing to their own specific physiological characteristics compared to the Western population. Although the association between OSAHS and bone metabolism may be confounded by underlying diseases, the association between them among healthy Chinese people remains unknown.

Objective

To examine the relationship between OSAHS and bone metabolism in Chinese people without underlying conditions using a review and Meta-analysis, providing evidence for improving bone health.

Methods

This review was conducted following the PRISMA guidelines. Electronic databases, such as PubMed, Embase, and CINAHL, were searched from inception to December 2020 for studies regarding bone metabolism and OSAHS in Chinese adults (aged≥18 years) in which those with and without OSAHS were classified as OSAHS and control groups, respectively (OSAHS was diagnosed based on the Guidelines for the Diagnosis and Management of Obstructive Sleep Apnea Hypopnea Syndrome) . Outcome indicators include one or more bone metabolism indicators. Three researchers independently performed literature screening and data extraction. Two researchers independently performed the quality appraisal using the JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies. Data were analyzed using Stata 15.1.

Results

Ten studies were included, with a total of 898 participants, and 653 of whom had OSAHS. Nine were cross-sectional studies and one was a quasi-experimental study. According to the JBI quality assessment tool, the nine cross-sectional studies were of high quality on items 1 to 5, and 4 of which did not control for the confounding factors. Based on the Meta-analysis, compared to the control group, OSAHS group had lower lumbar BMD 〔SMD (95%CI) =-1.758 (-2.300, -1.217) 〕, lower femoral neck BMD〔SMD (95%CI) =-1.260 (-1.949, -0.571) 〕, higher β-CTX〔SMD (95%CI) =0.803 (0.122, 1.484) 〕, and higher P1NP〔SMD (95%CI) =0.820 (0.318, 1.321) 〕. Apnea-hypopnea index had a negative correlation with lumbar BMD〔r (95%CI) =-0.36 (-0.57, -0.12) 〕 and positive correlations with β-CTX〔r (95%CI) =0.39 (0.29, 0.47) 〕and P1NP〔r (95%CI) =0.36 (0.16, 0.53) 〕.

Conclusion

Among Chinese adults without underlying conditions, OSAHS may reduce BMD by increasing bone resorption, thereby elevating the risk of osteoporosis or fractures.

Key words: Sleep apnea, obstructive, Apnea hypopnea index, Bone density, Bone metabolism, Systematic review, Meta-analysis

摘要:

背景

在西方人群中,阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与骨代谢存在相关性。与西方人群相比,我国人群在OSAHS的发生和发展及骨代谢方面具有自身的生理特点。此外,OSAHS与骨代谢的关系可能受到基础疾病的影响。在健康中国人群中,OSAHS与骨代谢的关系尚无定论。

目的

聚焦于未合并有基础疾病的中国人群,探讨OSAHS与骨代谢指标的关系,进而为改善骨代谢健康提供依据。

方法

按照PRISMA指南开展本综述,检索PubMed、Embase、CINAHL等电子数据库,检索时间为建库至2020年12月。根据《阻塞性睡眠呼吸暂停低通气综合征诊治指南(基层版)》诊断为OSAHS的成人(年龄≥18岁)为OSAHS组,未诊断为OSAHS的成人为对照组;结局指标包含骨代谢指标中的1项或多项。3位研究者对纳入文献进行独立文献筛选、资料提取,2位研究者采用Joanna Briggs Institute(JBI)工具对横断面研究进行独立质量评价,采用Stata 15.1软件进行数据分析。

结果

共纳入10篇文献,总样本量为898例(OSAHS组653例)。9项为横断面研究,1项为类试验性研究。根据JBI质量评价工具,9项横断面研究在条目1~5上质量均较高,有4项未控制混杂因素。Meta分析结果显示,与对照组相比,OSAHS组腰椎骨密度较低〔SMD(95%CI)=-1.758(-2.300,-1.217)〕、股骨颈骨密度较低〔SMD(95%CI)=-1.260(-1.949,-0.571)〕、Ⅰ型胶原羟基端肽β降解产物(β-CTX)较高〔SMD(95%CI)=0.803(0.122,1.484)〕、Ⅰ型前胶原氨基端前肽(P1NP)较高〔SMD(95%CI)=0.820(0.318,1.321)〕。呼吸暂停低通气指数与腰椎骨密度呈负相关〔r(95%CI)=-0.36(-0.57,-0.12)〕、与β-CTX呈正相关〔r(95%CI)=0.39(0.29,0.47)〕、与P1NP呈正相关〔r(95%CI)=0.36(0.16,0.53)〕。

结论

在未合并有基础疾病的中国人群中,OSAHS可能通过促进骨吸收而降低骨密度,进而促进骨质疏松或者骨折的发生。

关键词: 睡眠呼吸暂停,阻塞性, 睡眠呼吸暂停低通气指数, 骨密度, 骨代谢, 系统综述, Meta分析