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J Zhejiang Univ (Med Sci)  2020, Vol. 49 Issue (4): 431-438    DOI: 10.3785/j.issn.1008-9292.2020.08.01
    
Relationship between sleep quality and bone mineral density in urban residents
XIONG Mingjie(),LIU Xiang*(),YOU Li,CHEN Xiaolin
Health Management Center of Southwest University Hospital, Chongqing 400715, China
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Abstract  

Objective: To investigate the relationship between sleep quality and bone mineral density (BMD) in urban residents. Methods: Data of 28 756 Han adults (14 355 males and 14 401 females), who completed both Pittsburgh sleep quality index (PSQI) assessment and radial BMD tests by dual energy X-ray absorptiometry in the Health Management Center of Southwest China University from June 2012 to June 2019 were retrospectively analyzed. The degree of sleep disorder was determined based on PSQI scores, while osteopenia and osteoporosis was diagnosed according to BMD T-value. The χ2 test and multiple regression model were used to investigate the relationship between sleep quality and BMD. Results: The numbers of normal BMD, osteoponia and osteoporosis were 17 039 (59.3%), 7916(27.5%) and 3801(13.2%), respectively. The mean PSQI score was 5.6±1.4 points. According to PSQI scores, there were 15 936 subjects without sleep disorder (55.4%), 5965 with mild (20.7%), 4897 with moderate (17.0%) and 1958 with severe sleep disorder (6.8%), respectively. There was no significant difference in osteoponia/osteoporosis rate between subjects with mild sleep disorder and normal ones (χ2=0.948, P>0.05), while the rate of osteoporosis in moderate sleep disorder group was higher than that in mild group (χ2=525.583, P < 0.01), and the rate of osteoponia/osteoporosis in severe sleep disorder group was much higher than that in moderate group (χ2=1124.877, P < 0.01). Multiple regression results showed that female, elders, mental labor, smoking and higher PSQI scores were independently associated with lower T-value (all P < 0.05), while moderate to intense daily physical activity was associated with higher T-value (P < 0.05). Conclusion: Sleep disturbances may be a major risk factor for BMD loss in urban residents, indicating that it would be a potential target of osteoporosis prevention.



Key wordsSleep quality      Bone mineral density      Urban residents     
Received: 30 March 2020      Published: 27 September 2020
CLC:  R195.4  
  R589  
Corresponding Authors: LIU Xiang     E-mail: willy_pooh@126.com;407900254@qq.com
Cite this article:

XIONG Mingjie,LIU Xiang,YOU Li,CHEN Xiaolin. Relationship between sleep quality and bone mineral density in urban residents. J Zhejiang Univ (Med Sci), 2020, 49(4): 431-438.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2020.08.01     OR     http://www.zjujournals.com/med/Y2020/V49/I4/431


城市居民睡眠质量与骨量异常关系的调查分析

目的: 探索不同程度睡眠障碍对居民骨量的影响,为骨质疏松的早期防治提供科学依据。方法: 选取2012年6月至2019年6月在西南大学医院健康管理中心完成匹兹堡睡眠质量指数(PSQI)评分和双能X线桡骨远端骨密度检测的汉族成年人28 756名(男性14 355名,女性14 401名),依据PSQI评分判定睡眠情况,包括睡眠正常以及轻、中、重度睡眠障碍;以骨密度T值判定骨量情况,包括骨量正常、骨量减少、骨质疏松。采用卡方检验、多元回归分析法评估睡眠质量与骨量之间的相关性。结果: 28 756名受试者检出骨量正常17 039名(59.3%),骨量减少7916名(27.5%),骨质疏松3801名(13.2%);PSQI总分为(5.6±1.4)分,其中无睡眠障碍15 936名(55.4%),轻度睡眠障碍5965名(20.7%),中度睡眠障碍4897名(17.0%),重度睡眠障碍1958名(6.8%)。轻度睡眠障碍组骨质疏松的检出率与无睡眠障碍组差异无统计学意义(χ2=0.948,P>0.05)。中度睡眠障碍组骨质疏松的检出率高于轻度睡眠障碍组(χ2=525.583,P < 0.01);重度睡眠障碍组骨质疏松的检出率高于中度睡眠障碍组(χ2=1124.877,P < 0.01)。多元回归分析结果显示,女性、年龄增长、从事以脑力活动为主的职业、吸烟、PSQI总分高者其骨密度T值较低(均P < 0.05);而日常以中高强度体力活动为主者其T值较高(P < 0.05)。结论: 睡眠障碍可能是城市居民骨量流失的危险因素之一,提示其可作为预防骨质疏松的潜在靶点。


关键词: 睡眠质量,  骨密度,  城市居民 
年龄分组
(岁)
n 男性 工作状态
(脑力为主)
吸烟 饮酒 PSQI评分 日常体力活动 骨量检测
0~<6 7~<11 12~<16 17~21 轻度 中度 重度 T值 Z值 骨量正常 骨量减少 骨质疏松
PSQI:匹兹堡睡眠质量指数;T值:骨密度测量值与健康青年人平均值之差除以标准差所得的数值;Z值:骨密度测量值与同性别、同年龄健康人群平均值之差除以标准差所得的数值.
20~<30 2199 1228(55.8) 1487(67.6) 1071(48.7) 1568(71.3) 1350(61.4) 438(19.9) 377(17.1) 34(1.5) 636(28.9) 758(34.5) 805(36.6) 0.42±0.88 -0.12±1.20 1436(65.3) 722(32.8) 41(1.9)
30~<40 6347 3405(53.6) 4325(68.1) 3616(57.0) 3889(61.3) 3692(58.2) 1290(20.3) 1256(19.8) 109(1.7) 2215(34.9) 2818(44.4) 1314(20.7) -0.86±1.32 -0.26±0.79 5151(81.2) 1034(16.3) 162(2.6)
40~<50 5013 2369(47.3) 3799(75.8) 3210(64.0) 3413(68.1) 2643(52.7) 1240(24.7) 951(19.0) 179(3.6) 2023(40.4) 2645(52.8) 345(6.9) -1.15±1.18 0.26±1.34 2721(54.3) 1611(32.1) 681(13.6)
50~<60 7901 3866(48.9) 5721(72.4) 4851(61.4) 4836(61.2) 3812(48.2) 1936(24.5) 1338(16.9) 815(10.3) 3945(49.9) 3700(46.8) 256(3.2) -1.31±1.65 -0.42±0.96 4009(50.7) 2406(30.4) 1486(18.8)
≥60 7296 3487(47.8) 4029(55.2) 2890(39.6) 4482(61.4) 4439(60.8) 1061(14.5) 975(13.4) 821(11.3) 3264(44.7) 2030(27.8) 2002(27.4) -1.69±1.33 0.33±1.26 3722(51.0) 2143(29.4) 1431(19.6)
合计 28 756 14 355(49.9) 19 361(67.3) 15 638(54.4) 18 188(63.2) 15 936(55.4) 5965(20.7) 4897(17.0) 1958(6.8) 12 083(42.0) 11 951(41.6) 4722(16.4) -1.05±1.46 0.23±1.06 17 039(59.3) 7916(27.5) 3801(13.2)
Tab 1 General characteristics of included participants [n(%)或$\bar x \pm s$]
组别 n 骨量正常 骨量减少 骨质疏松
与无睡眠障碍组比较,*P<0.01;与轻度睡眠障碍组比较,#P<0.01;与中度睡眠障碍组比较,P<0.01.
无睡眠障碍组 15 936 10 252(64.33) 4554(28.58) 1130(7.09)
轻度睡眠障碍组 5965 3796(63.64) 1742(29.20) 427(7.16)
中度睡眠障碍组 4897 2715(55.44) 1086(22.18) 1096(22.38)*#
重度睡眠障碍组 1958 276(14.10) 534(27.27) 1148(58.63)*#△
合计 28 756 17 039(59.25) 7916(27.53) 3801(13.22)
Tab 2 Osteopenia/osteoporosis in people with different degrees of sleep disorders [n(%)]
变量 回归模型1 回归模型2 回归模型3
β(95%CI) P β(95%CI) P β(95%CI) P
“—”:无相关数据.以骨密度T值作为因变量,分三层控制自变量进行多元回归分析;模型1自变量纳入年龄、性别;模型2在模型1的基础上纳入自变量职业、吸烟、饮酒、日常体力活动等;模型3在模型2的基础上纳入自变量PSQI总分.PSQI:匹兹堡睡眠质量指数.
年龄(岁) -0.039(-0.074, -0.011) <0.05 -0.023(-0.043, -0.005) <0.05 -0.018(-0.039, 0.002) <0.05
性别(女性) -0.043(-0.071, -0.013) <0.05 -0.039(-0.067, -0.004) <0.05 -0.034(-0.062, 0, 014) <0.01
职业(脑力劳动为主) -0.133(-0.153, -0.027) <0.01 -0.164(-0.175, -0.013) <0.01
吸烟 -0.059(-0.104,0.034) <0.05 -0.068(-0.073, 0.011) <0.01
饮酒 0.007(-0.002, 0.015) >0.05 0.013(-0.016, 0.022) >0.05
日常体力活动强度
  小
  中 1.459(0.615, 2.642) <0.01 1.589(0.663, 2.835) < 0.01
  大 0.177(0.189, 0.354) <0.05 -0.097(-0.137, 0.004) <0.05
PSQI总分 -0.084(-0.125, -0.031) <0.05
Tab 3 Multiple regression analysis of bone mineral density
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