Self‐Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation
Abstract 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 prospectiv...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-08-01
|
| Series: | JBMR Plus |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jbm4.10762 |
| _version_ | 1797739517331898368 |
|---|---|
| author | Jane A. Cauley Howard M. Kravitz Kristine Ruppert Yinjuan Lian Martica J. Hall Sioban D. Harlow Joel S. Finkelstein Gail Greendale |
| author_facet | Jane A. Cauley Howard M. Kravitz Kristine Ruppert Yinjuan Lian Martica J. Hall Sioban D. Harlow Joel S. Finkelstein Gail Greendale |
| author_sort | Jane A. Cauley |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-12T13:58:17Z |
| format | Article |
| id | doaj.art-ed18f89a894447f5a4ab8d4d816c0ecf |
| institution | Directory Open Access Journal |
| issn | 2473-4039 |
| language | English |
| last_indexed | 2024-03-12T13:58:17Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | JBMR Plus |
| spelling | doaj.art-ed18f89a894447f5a4ab8d4d816c0ecf2023-08-22T11:14:27ZengWileyJBMR Plus2473-40392023-08-0178n/an/a10.1002/jbm4.10762Self‐Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the NationJane A. Cauley0Howard M. Kravitz1Kristine Ruppert2Yinjuan Lian3Martica J. Hall4Sioban D. Harlow5Joel S. Finkelstein6Gail Greendale7School of Public Health, Department of Epidemiology University of Pittsburgh Pittsburgh Pennsylvania USADepartment of Psychiatry and Behavioral Sciences Rush University Medical Center Chicago Illinois USASchool of Public Health, Department of Epidemiology University of Pittsburgh Pittsburgh Pennsylvania USASchool of Public Health, Department of Epidemiology University of Pittsburgh Pittsburgh Pennsylvania USADepartment of Psychiatry University of Pittsburgh Pittsburgh Pennsylvania USADepartment of Medicine, Endocrine Unit Massachusetts General Hospital Boston Massachusetts USADavid Geffen School of Medicine University of California Los Angeles California USADepartment of Epidemiology University of Michigan Ann Arbor Michigan USAAbstract 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.https://doi.org/10.1002/jbm4.10762FRACTUREGENERAL POPULATION STUDIESMENOPAUSEOSTEOPOROSISSLEEPSWAN |
| spellingShingle | Jane A. Cauley Howard M. Kravitz Kristine Ruppert Yinjuan Lian Martica J. Hall Sioban D. Harlow Joel S. Finkelstein Gail Greendale Self‐Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation JBMR Plus FRACTURE GENERAL POPULATION STUDIES MENOPAUSE OSTEOPOROSIS SLEEP SWAN |
| title | Self‐Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation |
| title_full | Self‐Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation |
| title_fullStr | Self‐Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation |
| title_full_unstemmed | Self‐Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation |
| title_short | Self‐Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation |
| title_sort | self reported sleep disturbances over the menopausal transition and fracture risk the study of women s health across the nation |
| topic | FRACTURE GENERAL POPULATION STUDIES MENOPAUSE OSTEOPOROSIS SLEEP SWAN |
| url | https://doi.org/10.1002/jbm4.10762 |
| work_keys_str_mv | AT janeacauley selfreportedsleepdisturbancesoverthemenopausaltransitionandfractureriskthestudyofwomenshealthacrossthenation AT howardmkravitz selfreportedsleepdisturbancesoverthemenopausaltransitionandfractureriskthestudyofwomenshealthacrossthenation AT kristineruppert selfreportedsleepdisturbancesoverthemenopausaltransitionandfractureriskthestudyofwomenshealthacrossthenation AT yinjuanlian selfreportedsleepdisturbancesoverthemenopausaltransitionandfractureriskthestudyofwomenshealthacrossthenation AT marticajhall selfreportedsleepdisturbancesoverthemenopausaltransitionandfractureriskthestudyofwomenshealthacrossthenation AT siobandharlow selfreportedsleepdisturbancesoverthemenopausaltransitionandfractureriskthestudyofwomenshealthacrossthenation AT joelsfinkelstein selfreportedsleepdisturbancesoverthemenopausaltransitionandfractureriskthestudyofwomenshealthacrossthenation AT gailgreendale selfreportedsleepdisturbancesoverthemenopausaltransitionandfractureriskthestudyofwomenshealthacrossthenation |