Zhang Shiyong, Liang Zixin, Zhong Yanlin, Luo Qingfeng, Wang Danni, Xia Bin, Wang Xudong, Kang Yunze, Zhou Zijian, Sheng Puyi, Yuan Jinqiu, Zhang Ziji, Wei Fuxin
Department of Orthopedics, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, Guangdong, China.
Department of Epidemiology and Biostatistics, Clinical Big Data Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, Guangdong, China.
Eur Spine J. 2025 Jan 27. doi: 10.1007/s00586-025-08669-4.
Sleep disorders are considered a risk factor for aging and skeletal degeneration, but their impact on intervertebral disc degeneration (IDD) remains unclear. The aim of this study was to assess associations between sleep characteristics and IDD, and to identify potential causal relationships.
Exposure factors included six unhealthy sleep characteristics: insomnia, short sleep duration (< 7 h), long sleep duration (≥ 9 h), evening chronotype, daytime sleepiness, and snoring. The primary outcomes included cervical disc degeneration (CDD) and lumbar disc degeneration (LDD). Firstly, we examined the associations between sleep characteristics and IDD risk in 368,348 participants from the UK Biobank using Cox proportional hazards model. Two-sample Mendelian randomization (MR) analyses were conducted to validate associations found in observational analyses, using genome-wide association data from the UK Biobank and FinnGen consortia.
During a median follow-up time of 13.8 years, a total of 1,637 cases of CDD and 7,654 cases of LDD were identified. Observational analyses found that almost all unhealthy sleep characteristics were associated with an elevated risk of IDD, except snoring. Conversely, the risk of IDD decreased linearly with an increasing number of healthy sleep characteristics. MR analyses supported a causal association between genetically determined insomnia and increased risk of LDD (OR 1.25 [1.07-1.47]), and between short sleep duration and increased risk of both IDD phenotypes (OR 5.41 [1.95-15.01] for CDD; OR 3.48 [1.76-6.89] for LDD). However, long sleep duration was causally associated with a reduced risk of LDD (OR 0.13 [0.03-0.53]), which contrasts with the observational findings.
We found associations between multiple sleep characteristics and IDD risk and confirmed that insomnia and short sleep duration increased IDD risk. Although more research is needed to confirm the underlying mechanisms, prioritizing interventions to improve sleep quality and ensure adequate sleep could help mitigate IDD.
睡眠障碍被认为是衰老和骨骼退化的一个风险因素，但其对椎间盘退变（IDD）的影响仍不明确。本研究的目的是评估睡眠特征与IDD之间的关联，并确定潜在的因果关系。
暴露因素包括六种不健康的睡眠特征：失眠、短睡眠时间（<7小时）、长睡眠时间（≥9小时）、晚睡型、日间嗜睡和打鼾。主要结局包括颈椎间盘退变（CDD）和腰椎间盘退变（LDD）。首先，我们使用Cox比例风险模型在来自英国生物银行的368348名参与者中研究了睡眠特征与IDD风险之间的关联。使用来自英国生物银行和芬兰基因联盟的全基因组关联数据进行两样本孟德尔随机化（MR）分析，以验证在观察性分析中发现的关联。
在中位随访时间13.8年期间，共确定了1637例CDD和7654例LDD。观察性分析发现，除打鼾外，几乎所有不健康的睡眠特征都与IDD风险升高有关。相反，IDD风险随着健康睡眠特征数量的增加而呈线性下降。MR分析支持遗传决定的失眠与LDD风险增加之间的因果关联（比值比1.25[1.07 - 1.47]），以及短睡眠时间与两种IDD表型风险增加之间的因果关联（CDD的比值比5.41[1.95 - 15.01]；LDD的比值比3.48[1.76 - 6.89]）。然而，长睡眠时间与LDD风险降低存在因果关联（比值比0.13[0.03 - 0.53]），这与观察性结果相反。
我们发现多种睡眠特征与IDD风险之间存在关联，并证实失眠和短睡眠时间会增加IDD风险。尽管需要更多研究来证实潜在机制，但优先采取干预措施改善睡眠质量并确保充足睡眠可能有助于减轻IDD。
