成人阻塞性睡眠呼吸暂停低通气综合征与骨密度降低及骨质疏松相关性的Meta分析

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)与骨密度降低及骨质疏松之间的相关性。方法从PubMed、EMBASE、Web of Science、the Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库(Wanfang data)和维普数据库(VIP)检索OSAHS与骨密度及骨质疏松相关性的研究。采用纽卡斯尔-渥太华量表(the Newcastle-Ottawa scale,NOS)对纳入研究进行质量评价。所有数据的合并、亚组分析采用Review manager 5.3软件,敏感性分析和发表偏倚检测采用Stata 15.1软件。结果检索到1091篇文献,1074篇文献被排除,17篇全文文献里的17项研究所包含的113460位研究对象的数据被提取。OSAHS组与对照组相比,骨质疏松症的发生率高(OR=1.74,95%CI:1.43~2.13,P<0.00001);性别、年龄的亚组分析显示,男性(OR=1.90,95%CI:1.33~2.72,P=0.0004)、女性(OR=2.56,95%CI:1.96~3.34,P<0.00001)、大于65岁老年人(OR=2.62,95%CI:1.86~3.71,P<0.00001)、40~65岁中年人(OR=1.73,95%CI:1.31~2.28,P=0.0001)骨质疏松症的发生率均高。OSAHS组与对照组相比,腰椎骨密度显著降低(MD=-0.12,95%CI:-0.18~-0.06,P=0.0001)。性别的亚组分析显示,男性腰椎骨密度显著降低(一般人群:MD=-0.08,95%CI:-0.15~-0.01,P=0.02;无伴随疾病人群:MD=-0.12,95%CI:-0.19~-0.05,P=0.0008);女性腰椎骨密度略低(MD=-0.08,95%CI:-0.21~0.06,P=0.27),但差异无统计学意义。OSAHS组与对照组相比,股骨颈骨密度显著降低(MD=-0.12,95%CI:-0.19~-0.05,P=0.0007)。男性亚组股骨颈骨密度显著降低(一般人群:MD=-0.09,95%CI:-0.17~-0.02,P=0.02,无伴随疾病人群:MD=-0.11,95%CI:-0.19~-0.03,P=0.006);女性亚组股骨颈骨密度略低(MD=-0.10,95%CI:-0.33~0.12,P=0.37),但差异无统计学意义。各项分析纳入的研究无明显发表偏倚。结论OSAHS组与对照组相比,骨质疏松症的发生率高,腰椎骨密度、股骨颈骨密度均有所降低。

A meta-analysis of association between obstructive sleep apnea-hypopnea syndrome and low bone mass in adults

Objective To assess the association between obstructive sleep apnea and low bone mass in adults.Methods Studies relevant to obstructive sleep apnea(OSA)and bone mass were identified through the databases including PubMed,EMBASE,Web of Science,the Cochrane Library,CBM,CNKI,Wanfang data and VIP.Selected studies were appraised based on the Newcastle-Ottawa Scale(NOS)for assessing risk of bias in observational studies.Analysis of data was performed with Review manager(Version 5.3),publication bias and sensitivity were performed with Stata(Version 15.1).Results 1091 articles were retrieved,1074 articles were excluded,17 studies(n=113460)met our inclusion criteria.Meta-analysis showed that OSA was a significant risk factor for osteoporosis(odds ratio(OR)=1.74,95%CI:1.43-2.13,P<0.00001);males had an OR of 1.90(95%CI:1.33-2.72,P=0.0004)while the OR in females was 2.56(95%CI:1.96-3.34,P<0.00001);elderly(>65 years old)had an OR of 2.62(95%CI:1.86-3.71,P<0.00001)while middle-aged people in their 40 s and 65 s had an OR of 1.73(95%CI:1.31-2.28,P=0.0001).There was a significant lower bone mineral density(BMD)at the lumbar spine in the OSA group with a pooled mean difference(MD)of-0.12(95%CI:-0.18--0.06,P=0.0001)compared with controls.Males had an MD of-0.08(95%CI:-0.15--0.01,P=0.02,subgroup of males without comorbidities:MD=-0.12,95%CI:-0.19--0.05,P=0.0008)while the MD in females was-0.08(95%CI:-0.21-0.06,P=0.27)。There was a significant lower BMD at the femur neck in the OSA group with a pooled MD of-0.12(95%CI:-0.19--0.05,P=0.0007)compared with controls.Males had an MD of-0.09(95%CI:-0.17--0.02,P=0.02,subgroup of males without comorbidities:MD=-0.11,95%CI:-0.19--0.03,P=0.006)while the MD in females was-0.10(95%CI:-0.33-0.12,P=0.37).No obvious publication bias was detected in all analysis.Conclusion Obstructive sleep apnea is a significant risk factor for osteoporosis.There is a significant lower BMD at the lumbar spine and femur in the OSA group compared with the control group.