Nature and Science of Sleep (Mar 2024)
Causal Relationship of Obstructive Sleep Apnea with Bone Mineral Density and the Role of BMI
Abstract
Fei Xu,1 XiuRong Zhang,2 YinRong Zhang,1 WenHui Chen,3 ZiCong Liao1 1General Surgery Department, Zhongshan Boai Hospital, Zhongshan, Guangdong, 528400, People’s Republic of China; 2Breast Surgery Department, Zhongshan Boai Hospital, Zhongshan, Guangdong, 528400, People’s Republic of China; 3Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510630, People’s Republic of ChinaCorrespondence: ZiCong Liao, General Surgery Department, Zhongshan Boai Hospital affiliated to Southern Medical University, No. 6 Chenggui Road, East Street, Zhongshan, Guangdong, 528400, People’s Republic of China, Tel +86 76088776658, Email [email protected] WenHui Chen, Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613 Huangpu Avenue West, Guangzhou, Guangdong, 510630, People’s Republic of China, Tel +86 13129349492, Fax +86 20 38688608, Email [email protected]: Observational studies have yielded conflicting evidence concerning the relationships between obstructive sleep apnea (OSA) and bone mineral density (BMD). As the exact causal inferences remain inconclusive, we conducted a two-sample Mendelian randomization (MR) to identify the causal associations between OSA and BMD.Methods: Single-nucleotide polymorphisms associated with OSA were extracted from the FinnGen study. Summary statistics for 10 BMD measured at different age or skeletal sites were obtained from the publicly available IEU GWAS database. Inverse-variance weighted (IVW) method was chosen as the primary analysis, combined with several sensitivity analyses to evaluate the robustness of results. The study design included two-sample MR and network MR.Results: Our primary MR analysis revealed that genetically predicted OSA was positively linked to increased forearm BMD (β = 0.24, 95% confidence interval [CI]: 0.06– 0.41, p = 0.009) and heel BMD (β=0.10, 95% CI = 0.02– 0.18, p = 0.018), while no significant causal relationships were observed between OSA and total body BMD, lumbar spine BMD, or femoral neck BMD (all p > 0.05). Network MR suggests that OSA might act as a mediating factor in the effect of BMI on forearm BMD and heel BMD, with a mediated portion estimated at 73% and 84%, respectively.Conclusion: Our findings provide support for a causal relationship between genetically predicted OSA and increased forearm BMD and heel BMD. Furthermore, our results suggest that OSA may play a role in mediating the influence of BMI on BMD.Keywords: obstructive sleep apnea, bone mineral density, BMI, Mendelian randomization
