Bone Metabolic Markers in Patients with Obstructive Sleep Apnea Syndrome

Background: Obstructive sleep apnea syndrome (OSAS) is prevalent in obesity and is associated with many metabolic abnormalities. The relationship between OSAS and bone metabolism is still unclear. The aim of this study was to investigate the relationship between the severity of OSAS and bone metabolic markers. Methods: A total of 119 obese males were enrolled in this study in spring months from 2015 to 2017. All candidates underwent polysomnography, and their bone mineral density (BMD) and the serum levels of total procollagen type 1 N-terminal propeptide (t-P1NP), N-terminal midfragment of osteocalcin (N-MID), &bgr;-C-terminal telopeptide of type 1 collagen (&bgr;-CTX), vitamin D (VD), and parathyroid hormone (PTH) were measured. The analysis of variance and Pearson correlation analysis were performed for data analyses. Results: No significant differences in the mean values of BMD were observed among the obesity, mild-to-moderate OSAS, and severe OSAS groups; and the serum levels of t-P1NP and &bgr;-CTX in the severe OSAS group were significantly higher than those in the obesity group (48.42 ± 23.78 ng/ml vs. 31.98 ± 9.85 ng/ml, P < 0.001; 0.53 ± 0.24 ng/ml vs. 0.41 ± 0.13 ng/ml, P = 0.011, respectively). The serum level of VD in the obesity group was significantly higher than those in the mild-to-moderate and severe OSAS groups (both P < 0.001), and decreased as the severity of OSAS increased (P < 0.001). The serum level of PTH in the severey and mild-to-moderate OSAS groups (both P < 0.001). The results of correlation analysis indicated that the level of apnea-hypopnea index (AHI) was correlated with the levels of t-P1NP (r = 0.396, P < 0.001), VD (r = –0.404, P < 0.001), and PTH (r = 0.400, P < 0.001), whereas the level of minimum O2 saturation (SaO2 min) was correlated with the levels of VD (r = 0.258, P = 0.016) and PTH (r = –0.376, P < 0.001). Conclusions: The levels of bone resorption and formation markers in patients with severe OSAS were significantly increased compared to obese men, and the severity of OSAS was correlated with the serum levels of t-P1NP, VD, and PTH.

[1]  Meng Li,et al.  Retinal Vascular Morphological Changes in Patients with Extremely Severe Obstructive Sleep Apnea Syndrome , 2017, Chinese medical journal.

[2]  M. Greenblatt,et al.  Bone Turnover Markers in the Diagnosis and Monitoring of Metabolic Bone Disease. , 2017, Clinical chemistry.

[3]  N. Thomas,et al.  Bone turnover markers: Emerging tool in the management of osteoporosis , 2016, Indian journal of endocrinology and metabolism.

[4]  J. Luo,et al.  Adult Monosymptomatic Nocturnal Enuresis with Obstructive Sleep Apnea Syndrome , 2016, Chinese medical journal.

[5]  H. Knowles.  Hypoxic regulation of osteoclast differentiation and bone resorption activity , 2015, Hypoxia.

[6]  L. Wang,et al.  Changes of visual field and optic nerve fiber layer in patients with OSAS , 2015, Sleep and Breathing.

[7]  C. Marcus,et al.  Interrelationships between obesity, obstructive sleep apnea syndrome and cardiovascular risk in obese adolescents , 2015, International Journal of Obesity.

[8]  Andrew A. Marino,et al.  The link between vitamin D metabolism and sleep medicine. , 2014, Sleep medicine reviews.

[9]  K. Kario,et al.  Obstructive sleep apnea syndrome as a cause of resistant hypertension , 2014, Hypertension Research.

[10]  L. Kheirandish-Gozal,et al.  Vitamin D levels and obstructive sleep apnoea in children. , 2014, Sleep medicine.

[11]  C. Erem,et al.  Investigation of serum bisphenol A, vitamin D, and parathyroid hormone levels in patients with obstructive sleep apnea syndrome , 2014, Endocrine.

[12]  G. Andreou,et al.  Effects of Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea on Cognitive Functions: Evidence for a Common Nature , 2014, Sleep disorders.

[13]  E. Sforza,et al.  Obstructive sleep apnea is associated with preserved bone mineral density in healthy elderly subjects. , 2013, Sleep.

[14]  H. Datta,et al.  The clinical utility of bone marker measurements in osteoporosis , 2013, Journal of Translational Medicine.

[15]  F. Mohammadi,et al.  Evaluation of quality of life in patients with obstructive sleep apnea , 2013, European Archives of Oto-Rhino-Laryngology.

[16]  H. Kaynar,et al.  Bone mineral density in patients with obstructive sleep apnea syndrome , 2013, Sleep and Breathing.

[17]  J. Montserrat,et al.  Vitamin D Status and Parathyroid Hormone Levels in Patients with Obstructive Sleep Apnea , 2012, Respiration.

[18]  L. Varone,et al.  Obstructive sleep apnea and bone mineral density in obese patients , 2012, Diabetes, metabolic syndrome and obesity : targets and therapy.

[19]  Liang-Yi Si,et al.  Obstructive sleep apnea syndrome (OSAS) and hypertension: Pathogenic mechanisms and possible therapeutic approaches , 2012, Upsala journal of medical sciences.

[20]  F. Masedu,et al.  Cardiovascular and metabolic comorbidities in patients with obstructive sleep apnoea syndrome , 2012, Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale.

[21]  S. Ancoli-Israel,et al.  Cognition in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAS): Current Clinical Knowledge and the Impact of Treatment , 2012, NeuroMolecular Medicine.

[22]  C. Lamberg-Allardt.  Vitamin D in children and adolescents , 2012, Scandinavian journal of clinical and laboratory investigation. Supplementum.

[23]  M. Daulatzai.  Pathogenesis of Cognitive Dysfunction in Patients with Obstructive Sleep Apnea: A Hypothesis with Emphasis on the Nucleus Tractus Solitarius , 2012, Sleep disorders.

[24]  Jay J Cao.  Effects of obesity on bone metabolism , 2011, Journal of orthopaedic surgery and research.

[25]  L. Dai,et al.  The roles of the sympathetic nervous system in osteoporotic diseases: A review of experimental and clinical studies , 2011, Ageing Research Reviews.

[26]  J. Gallagher,et al.  Relationship between vitamin D, parathyroid hormone, and bone health. , 2011, The Journal of clinical endocrinology and metabolism.

[27]  C. Cooper,et al.  Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards , 2011, Osteoporosis International.

[28]  T. Arnett.  Acidosis, hypoxia and bone. , 2010, Archives of biochemistry and biophysics.

[29]  A. Flanagan,et al.  Hypoxia stimulates osteoclast formation from human peripheral blood , 2010, Cell biochemistry and function.

[30]  G. Loots,et al.  Hypoxia decreases sclerostin expression and increases Wnt signaling in osteoblasts , 2010, Journal of cellular biochemistry.

[31]  Li Sun,et al.  Role of mitochondrial reactive oxygen species in osteoclast differentiation , 2010, Annals of the New York Academy of Sciences.

[32]  Francisco Lopez-Jimenez,et al.  Interactions between obesity and obstructive sleep apnea: implications for treatment. , 2010, Chest.

[33]  P. Chanson,et al.  Endocrine aspects of obstructive sleep apnea. , 2010, The Journal of clinical endocrinology and metabolism.

[34]  H. Hashimoto,et al.  Link between obstructive sleep apnea and increased bone resorption in men , 2008, Osteoporosis International.

[35]  H. Yoshikawa,et al.  Oxygen tension is an important mediator of the transformation of osteoblasts to osteocytes , 2007, Journal of Bone and Mineral Metabolism.

[36]  T. Arnett,et al.  Hypoxia is a major stimulator of osteoclast formation and bone resorption , 2003, Journal of cellular physiology.