Sha Tingting, Wang Yilun, Zhang Yuqing, Zhang Jian, Lu Cong, Wei Jie, Lei Guanghua, Zeng Chao
Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.
Int J Surg. 2025 May 12. doi: 10.1097/JS9.0000000000002491.
Unhealthy sleep behaviors may contribute to osteoarthritis (OA), but their interrelated nature complicates evaluation and longitudinal studies examining the correlation between overall sleep behaviors and OA incidence are lacking. We explored the impact of sleep patterns on OA incidence and investigated whether genetic susceptibility plays a modifying role.
We analyzed 369,795 OA-free participants from the UK Biobank (discover cohort). A composite sleep score was derived from five behaviors: sleep duration, snoring, chronotype, daytime sleepiness, and insomnia symptoms. Incident site-specific OA were identified using ICD-codes. Genetic risk scores (GRS) were calculated. Cox regression models were used to estimated hazard ratios (HR) and 95% confidence intervals (CI). Finally, we verified the association between sleep patterns and OA in the Xiangya Osteoarthritis Study (validation cohort).
During a median follow-up of 11.9 years, 17,152 knee, 11,101 hip, and 2,714 hand OA cases were recorded. Participants with the lowest sleep scores (0-1) had significantly higher OA risks, showing a 32% increased risk for knee OA, 19% for hip OA, and 42% for hand OA. Poor sleep patterns were associated with elevated OA risk across all GRS categories, though not all associations reached statistically significant. For knee OA, HRs were 1.13 (95% CI: 0.95-1.34), 1.22 (95% CI: 1.11-1.34), and 1.16 (95% CI: 1.00-1.36) in the low, intermediate, and high GRS groups, with similar trends for hip and hand OA. The validation cohort further supported a dose-response relationship, with intermediate and poor sleep patterns linked to higher risks of knee (Ptrend = 0.026) and hand OA (Ptrend = 0.041), relative to healthy sleep.
These findings demonstrates that an optimal sleep pattern is associated with a decreased OA risk, independent of genetic susceptibility. Our results emphasize the protective role of sleep in OA prevention and the importance of integrating sleep assessment into prevention strategies.
不健康的睡眠行为可能会导致骨关节炎（OA），但其相互关联的性质使评估变得复杂，且缺乏关于整体睡眠行为与OA发病率之间相关性的纵向研究。我们探讨了睡眠模式对OA发病率的影响，并研究了遗传易感性是否起调节作用。
我们分析了英国生物银行中369,795名无OA的参与者（发现队列）。综合睡眠评分由五种行为得出：睡眠时间、打鼾、昼夜节律类型、日间嗜睡和失眠症状。使用国际疾病分类代码识别特定部位的新发OA。计算遗传风险评分（GRS）。采用Cox回归模型估计风险比（HR）和95%置信区间（CI）。最后，我们在湘雅骨关节炎研究（验证队列）中验证了睡眠模式与OA之间的关联。
在中位随访11.9年期间，记录了17,152例膝关节OA、11,101例髋关节OA和2,714例手部OA病例。睡眠评分最低（0 - 1分）的参与者患OA的风险显著更高，膝关节OA风险增加32%，髋关节OA风险增加19%，手部OA风险增加42%。尽管并非所有关联都具有统计学意义，但在所有GRS类别中，不良睡眠模式都与OA风险升高相关。对于膝关节OA，低、中、高GRS组的HR分别为1.13（95%CI：0.95 - 1.34）、1.22（95%CI：1.11 - 1.34）和1.16（95%CI：1.00 - 1.36），髋关节和手部OA也有类似趋势。验证队列进一步支持了剂量反应关系，与健康睡眠相比，中等和不良睡眠模式与膝关节OA（Ptrend = 0.026）和手部OA（Ptrend = 0.041）的较高风险相关。
这些发现表明，最佳睡眠模式与OA风险降低相关，且与遗传易感性无关。我们的结果强调了睡眠在OA预防中的保护作用以及将睡眠评估纳入预防策略的重要性。
