背景:不健康的睡眠行为与骨质疏松症(OP)的高风险有关,而未来的证据是有限的。本研究旨在前瞻性地调查这种关联,量化不健康睡眠行为导致OP发病率降低的归因负担,并探索遗传风险因素的潜在修饰。
方法:这项纵向队列研究是利用英国生物银行的数据进行的,包括293,164名最初没有OP的参与者,基线时具有必要的睡眠行为数据。我们在招募后跟踪参与者,直到2022年11月30日,以确定事件OP。我们评估了五种睡眠行为的关联,包括睡眠时间,时间型,失眠,白天打盹,和早晨醒来的困难,以及根据上述睡眠行为确定的睡眠行为模式,有OP的风险,使用Cox模型调整多个混杂因素。然后在不同OP易感性的个体中分别进行分析,以OP的标准多遗传风险评分(PRS)为索引。我们的次要结果是OP伴病理性骨折。进行亚组和敏感性分析。此外,计算了暴露人群的归因风险百分比(AR%)和睡眠行为的人群归因分数(PAF)。
结果:中位随访时间为13.7年,记录了8253例新发OP病例。不健康的睡眠行为,例如长或短的睡眠持续时间,失眠,白天打盹,早晨醒来的困难,和不健康的睡眠模式,与健康睡眠行为相比,与OP风险升高相关(HR范围为1.14至1.46,所有P值<0.001)。观察到OP与病理性骨折的相似关联。在健康的睡眠模式和组成部分中,失眠表现出最大的AR%,为39.98%(95CI:36.46,43.31)和PAF为33.25%(95CI:30.00,36.34)。在睡眠行为和OPPRS对OP风险之间观察到统计学上显著的乘法相互作用(所有P相互作用<0.001)。
结论:四种不健康的睡眠行为和睡眠行为模式与OP风险增加有关,失眠对OP发病率的影响最大,而OP的遗传风险改变了这种关联。这些发现强调了坚持健康睡眠行为对有效预防OP的关键作用。
BACKGROUND: Unhealthy sleep behaviors are associated with higher risks of osteoporosis (OP), while prospective evidence is limited. This study aimed to prospectively investigate this association, quantify the attributable burden of OP incidence reduction due to unhealthy sleep behaviors, and explore potential modifications by genetic risk factors.
METHODS: This longitudinal cohort study was conducted utilizing data from the UK Biobank, comprising 293,164 participants initially free of OP and with requisite sleep behaviors data at baseline. We followed the participants after recruitment until November 30, 2022, to ascertain incident OP. We assessed the associations of five sleep behaviors including sleep duration, chronotype, insomnia, daytime napping, and morning wake-up difficulties, as well as sleep behavior patterns identified based on the above sleep behaviors, with the risk of OP, using Cox models adjusted for multiple confounders. The analyses were then performed separately among individuals with different OP susceptibility, indexed by standard polygenetic risk scores(PRS) for OP. Our secondary outcome was OP with pathologic fracture. Subgroup and sensitivity analyses were performed. Additionally, attributable risk percent in the exposed population (AR%) and population attributable fraction (PAF) of sleep behaviors were calculated.
RESULTS: Over a median follow-up of 13.7 years, 8253 new-onset OP cases were documented. Unhealthy sleep behaviors, such as long or short sleep duration, insomnia, daytime napping, morning wake-up difficulties, and unhealthy sleep patterns, were associated with elevated risks of OP (HRs ranging from 1.14 to 1.46, all P-value <0.001) compared to healthy sleep behaviors. Similar associations were observed for OP with pathologic fractures. Insomnia exhibited the largest AR% of 39.98 % (95%CI: 36.46, 43.31) and PAF of 33.25 % (95%CI: 30.00, 36.34) among healthy sleep patterns and components. A statistically significant multiplicative interaction was noted between sleep behaviors and OP PRS on OP risk (all P-interaction <0.001).
CONCLUSIONS: Four unhealthy sleep behaviors and sleep behavior patterns were associated to increased OP risk, with insomnia contributing the most to OP incidence, while genetic risk for OP modified this association. These findings underscore the crucial role of adhering to healthy sleep behaviors for effective OP prevention.