Department of Orthopaedic Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China.
College of Basic Medical Sciences, Jilin University, Changchun, Jilin, 130021, China.
J Orthop Surg Res. 2024 Sep 12;19(1):563. doi: 10.1186/s13018-024-05031-0.
Accumulating evidence has suggested that sleep disturbances and disorders are common in patients who undergo knee arthroplasty. Revision surgery represents one of the most catastrophic outcomes of knee arthroplasty. However, it remains unclear whether sleep traits are the causes or consequences of knee arthroplasty revision. This study aimed to genetically examine the relationships between sleep traits and knee arthroplasty revision.
To determine the causal relationship between sleep traits and knee arthroplasty revision, we employed two-sample Mendelian randomization (MR) using summary statistics from the largest publicly available genome-wide association studies (GWASs). The MR design uses genetic variants as instrumental variables to help separate causal relationships from non-causal associations. The main analyses included an inverse variance weighted (IVW) meta-analysis to obtain primary effect estimates. Sensitivity analyses involving the weighted median approach and MR-Egger regression were also conducted to check for potential pleiotropic biases. Numerous complementary sensitivity analyses were also performed to identify statistically significant causal correlations when there were horizontal pleiotropy and heterogeneity across variants. Finally, a reverse MR analysis was performed to evaluate the possibility of reverse causation.
In the absence of heterogeneity and horizontal pleiotropy, the IVW method revealed that genetically-predicted short sleep duration short sleep duration (average sleep duration of 24 h is 6 h or less) was positively correlated with the risk of knee arthroplasty revision (odds ratio = 1.03, 95% confidence interval = 1.01-1.05, and P = 0.003), while the association between genetically-predicted long sleep duration and knee arthroplasty was negative. The reverse MR analysis did not yield evidence supporting reverse causality relation between knee arthroplasty revision and sleep phenotypes.
This research indicated that, of the 10 sleep phenotypes we analyzed, only sleep duration was causally associated with knee arthroplasty revision. These discoveries added to the understanding of the role of sleep traits in the etiology of knee arthroplasty revision, which might further expand our insights into the prevention of knee arthroplasty revision.
越来越多的证据表明，睡眠障碍和紊乱在接受膝关节置换术的患者中很常见。翻修手术是膝关节置换术最灾难性的结果之一。然而，目前尚不清楚睡眠特征是膝关节置换术翻修的原因还是结果。本研究旨在从遗传学角度研究睡眠特征与膝关节置换术翻修之间的关系。
为了确定睡眠特征与膝关节置换术翻修之间的因果关系，我们使用了来自最大的公开全基因组关联研究（GWAS）的汇总统计数据，采用两样本 Mendelian 随机化（MR）方法。MR 设计使用遗传变异作为工具变量，以帮助将因果关系与非因果关系区分开来。主要分析包括逆方差加权（IVW）荟萃分析以获得主要效应估计。还进行了加权中位数方法和 MR-Egger 回归的敏感性分析，以检查潜在的偏倚。当变体之间存在水平多效性和异质性时，还进行了许多其他敏感性分析，以确定具有统计学意义的因果相关性。最后，进行了反向 MR 分析，以评估反向因果关系的可能性。
在不存在异质性和水平多效性的情况下，IVW 方法表明，遗传预测的短睡眠时间（24 小时平均睡眠时间为 6 小时或更短）与膝关节置换术翻修的风险呈正相关（比值比=1.03，95%置信区间=1.01-1.05，P=0.003），而遗传预测的长睡眠时间与膝关节置换术呈负相关。反向 MR 分析没有提供支持膝关节置换术翻修与睡眠表型之间存在反向因果关系的证据。
本研究表明，在所分析的 10 种睡眠表型中，只有睡眠时间与膝关节置换术翻修有因果关系。这些发现增加了对睡眠特征在膝关节置换术翻修病因学中作用的理解，这可能进一步扩展我们对膝关节置换术翻修预防的认识。
