Sleep Apnea May Increase Osteoporosis Risk

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Harvard Medical School
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Sleep Apnea May Increase Osteoporosis Risk

News Review From Harvard Medical School

April 16, 2014

News Review From Harvard Medical School -- Sleep Apnea May Increase Osteoporosis Risk

People with sleep apnea are more likely to develop high blood pressure, heart disease and stroke. But a new study finds that this common breathing disorder could also increase their risk of developing osteoporosis, a bone-thinning disease. The study took place in Taiwan. Researchers examined the medical records of close to 1,400 people diagnosed with sleep apnea from 2000 to 2008. Over the next 6 years, they kept track of how many in this group were diagnosed with osteoporosis compared to a group of over 20,000 who did not have sleep apnea. Those with sleep apnea were 2.7 times more likely to get osteoporosis. The study was published in the Journal of Clinical Endocrinology & Metabolism. HealthDay News reported on it April 15.


By Howard LeWine, M.D.
Harvard Medical School


What Is the Doctor's Reaction?

Obstructive sleep apnea is the most common type of sleep-disordered breathing. During sleep, it's normal for our muscles around the upper airway to relax. In people with obstructive sleep apnea, the relaxed muscles block the airway.

This results in abnormal breathing during sleep. A person with sleep apnea has frequent, short episodes when breathing becomes very shallow or stops.

Obstructive sleep apnea can cause a wide variety of symptoms, such as:

  • Loud snoring
  • Headaches, especially morning headaches
  • Daytime drowsiness (for example, people with sleep apnea often fall asleep while driving, in meetings, on the telephone, etc.)
  • Not feeling refreshed after a night’s sleep
  • Nighttime restlessness
  • Difficulty concentrating
  • Decreased sex drive
  • Bizarre dreams, or absence of dreams altogether

The disorder has been associated with multiple other medical problems. People with sleep apnea are more likely to:

  • Be obese
  • Have high blood pressure
  • Develop heart disease
  • Have a stroke
  • Be depressed

This study found that people with obstructive sleep apnea also appear to be at increased risk of thin bones (osteoporosis). However, this was an observational study. This kind of study shows links between factors. The results, therefore, don’t prove that sleep apnea directly causes osteoporosis.


What Changes Can I Make Now?

For most people with sleep apnea, doctors recommend:

  • Losing weight if you are overweight.
  • Getting more exercise.
  • Cutting way back on sugary foods and drinks.
  • Sleeping on your side instead of your back. This may take pressure off your upper airway.
  • Avoiding alcohol, sedatives and muscle relaxants.

It’s interesting that sleep apnea is much more common in people who are overweight. But it’s just the opposite for osteoporosis. Lower weight people, especially women, have a higher risk of osteoporosis.

The best treatment for obstructive sleep apnea is CPAP (continuous positive airway pressure). You wear a mask at night. The mask is connected to a small machine that creates steady air pressure and sends it into the mask. The air pressure makes your airway less likely to collapse. Up to 80% of people benefit from using a CPAP device.

To maintain bone health, you should make sure you get enough calcium in your diet and enough vitamin D. There are plenty of foods rich in calcium. But few foods contain natural vitamin D. So, you may need a daily vitamin D supplement.

Also you need to do regular weight-bearing physical activities to keep bones strong. Examples include walking or jogging, and resistance training using free weights or machines.


What Can I Expect Looking to the Future?

Currently, most experts recommend bone density testing to screen for osteoporosis in women age 65 or older. Future studies will be needed to determine if younger women and men with sleep apnea should routinely be screened with bone density testing.

Last updated April 16, 2014

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