Self-Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation.
Self-Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation.
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DOI：
10.1002/jbm4.10762
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发表时间：
2023-08
期刊：
影响因子：
3.8
通讯作者：
Greendale, Gail
中科院分区：
文献类型：
--
作者：
Cauley, Jane A.;Kravitz, Howard M.;Ruppert, Kristine;Lian, Yinjuan;Hall, Martica J.;Harlow, Sioban D.;Finkelstein, Joel S.;Greendale, Gail
睡眠障碍很常见，可能通过影响骨转换直接影响骨折风险，或通过共同的风险因素或介质间接影响骨折风险。为了调查绝经过渡期 (MT) 期间自我报告的睡眠障碍与骨折之间的关联，我们前瞻性地研究了参加全国妇女健康研究 (SWAN) 的 3101 名女性。在间隔约 18 个月的 14 次研究访问中，每一次都使用标准化验证量表确定了入睡困难、夜间醒来多次以及比计划早起的情况。对两种随时间变化的暴露进行建模：每周至少出现三种干扰中的任何一种，每周至少三次在夜间醒来几次。根据固定（种族/民族、研究地点）和随时间变化的特征（年龄、体重指数和 MT 阶段）调整基础模型。完全调整的模型还包括随时间变化的对骨骼有益和有害的药物、吸烟、酒精、体力活动、糖尿病、抑郁症和睡眠药物以及抑郁症状。经历过骨折的女性更有可能出现入睡困难、多次醒来和/或早醒的频率更高：基线时分别为 35% 和 30%，p = 0.02。在基础模型中，每周至少出现三种睡眠障碍中的任何一种的女性发生任何骨折的风险较高，比值比 (OR) = 1.23（95% 置信区间，1.02, 1.48）和非创伤性骨折，OR = 1.36（1.03, 1.80）。在完全调整的模型中，这些关联在很大程度上被削弱到不显着。将我们的样本限制为 2315 名参加骨矿物质密度 (BMD) 中心的 SWAN 女性的敏感性分析得出了类似的结果。对股骨颈 BMD 的额外调整对我们的结果没有影响。总之，自我报告的睡眠障碍与骨折风险增加相关，但这些关联可能反映了共同的风险因素或因果路径中的因素。 © 2023 作者。 JBMR Plus 由 Wiley periodicals LLC 代表美国骨与矿物研究学会出版。
Sleep disturbances are common and may impact fracture risk directly by influencing bone turnover or indirectly through shared risk factors or mediators. To investigate the association between self‐reported sleep disturbances across the menopausal transition (MT) and fractures, we prospectively studied 3101 women enrolled in the Study of Women's Health Across the Nation (SWAN). At each of 14 study visits spaced approximately 18 months apart, a standardized validated scale ascertained trouble falling asleep, waking up several times during the night, and waking up earlier than planned. Two time‐varying exposures were modeled: presence of any of the three disturbances at least three times per week and waking up several times during the night at least three times per week. Base models adjusted for fixed (race/ethnicity, study site) and time‐varying characteristics (age, body mass index, and MT stage). Fully adjusted models also included time‐varying bone beneficial and detrimental medications, smoking, alcohol, physical activity, diabetes, depression and sleep medications, and depressive symptoms. Women who experienced a fracture were more likely to report a greater frequency of having trouble falling asleep, waking up several times, and/or waking up earlier: 35% versus 30% at baseline, p = 0.02. In the base models, women who had any of the three sleep disturbances at least three times per week had a higher risk of any fracture, odds ratio (OR) = 1.23 (95% confidence intervals, 1.02, 1.48) and nontraumatic fracture, OR = 1.36 (1.03, 1.80). These associations were largely attenuated to nonsignificance in the fully adjusted model. Sensitivity analyses limiting our sample to 2315 SWAN women enrolled in the bone mineral density (BMD) centers yielded similar results. Additional adjustment for femoral neck BMD had no effect on our results. In conclusion, self‐reported sleep disturbances were associated with an increased risk of fractures, but these associations likely reflect shared risk factors or factors in the causal pathway. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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影响因子：
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作者：
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通讯作者：
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DOI：
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