Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China.
Department of Orthopedics No. 2 (Spinal Surgery), Guangdong Provincial Hospital of Chinese Medicine, Zhuhai, China.
Front Public Health. 2022 Aug 18;10:980352. doi: 10.3389/fpubh.2022.980352. eCollection 2022.
Previous studies assessed the relationship between individual sleep behavior and fracture risk, rather than taking into account the joint complexity of the sleep behaviors. We aimed to explore the association between sleep pattern and risk of imminent recurrent osteoporotic fracture in older hospitalized patients due to an index osteoporotic fracture, where sleep pattern was evaluated as a combination incorporating five common sleep behaviors (i.e., insomnia, snoring, nocturnal sleep duration, daytime napping, and midnight waking up).
We used data from a prospective cohort study for analyses. Patients who aged not < 55 years and were admitted to the hospital due to an index osteoporotic fracture were recruited. Sleep pattern was grouped as healthy, intermediate, and poor pattern, based on the categorization of overall sleep scores. We used Cox proportional hazard models to explore sleep pattern in relation to imminent recurrent fracture.
We included a total of 185 elderly hospitalized patients for analyses with mean (± standard deviation) age = 71.5 ± 10.3 years and 87.0% female. During a mean follow-up of 14.7 months, there were 10 (5.4%) recurrent osteoporotic fractures observed. A significantly higher overall sleep score was found in patients with recurrent fractures when compared with those without fractures (3.20 vs. 2.36, = 0.038). Both intermediate ( = 0.76) and poor sleep patterns ( = 0.093) were non-significantly associated with an elevated risk of fracture when compared with a healthy pattern. Per-one-increase in the overall sleep score was significantly related to an increased risk of fracture: hazard ratio = 1.60 (95% confidence interval: 1.00--2.55) from the multivariable model.
Per-one-increase in the overall sleep score was found to be significantly associated with a 60% higher risk of imminent recurrent osteoporotic fracture in the elderly, and intermediate and poor sleep patterns were non-significantly related to an increased risk of recurrent fracture. More high-quality evidence is required to further evaluate the relationship between the sleep pattern and the risk of recurrent osteoporotic fracture in the elderly.
先前的研究评估了个体睡眠行为与骨折风险之间的关系，而没有考虑到睡眠行为的复杂性。我们旨在探讨睡眠模式与因骨质疏松性骨折而住院的老年患者再次发生骨质疏松性骨折风险之间的关系，其中睡眠模式被评估为结合五种常见睡眠行为（即失眠、打鼾、夜间睡眠时间、白天小睡和午夜醒来）的组合。
我们使用前瞻性队列研究的数据进行分析。招募年龄<55 岁且因骨质疏松性骨折住院的患者。根据总体睡眠评分的分类，将睡眠模式分为健康、中等和较差模式。我们使用 Cox 比例风险模型探讨睡眠模式与即将发生的骨折复发之间的关系。
我们共纳入了 185 名老年住院患者进行分析，平均（±标准差）年龄=71.5±10.3 岁，87.0%为女性。在平均 14.7 个月的随访期间，观察到 10 例（5.4%）再次发生骨质疏松性骨折。与未发生骨折的患者相比，发生骨折的患者总体睡眠评分明显较高（3.20 与 2.36，=0.038）。与健康模式相比，中等（=0.76）和较差（=0.093）的睡眠模式与骨折风险增加无显著相关性。总体睡眠评分每增加一个单位，骨折风险显著增加：多变量模型中，危险比=1.60（95%置信区间：1.00-2.55）。
总体睡眠评分每增加一个单位，与老年人即将发生的骨质疏松性骨折再发风险增加 60%显著相关，而中等和较差的睡眠模式与骨折再发风险增加无显著相关性。需要更多高质量的证据来进一步评估睡眠模式与老年人骨质疏松性骨折再发风险之间的关系。
