Archives of Osteoporosis

, 13:19 | Cite as

Sleep apnea and femoral neck BMD among Singaporean mid-life women

  • Han Ying Tng
  • Win Pa Pa Thu
  • Susan Logan
  • Izzuddin M. Aris
  • Jane Cauley
  • Eu Leong YongEmail author
Original Article



The relationship between sleep apnea and bone health remains controversial. This study explored the relationship between sleep apnea and femoral neck BMD in midlife Asian women. Partner-witnessed apnea predicted higher femoral neck BMD, an effect validated by the STOP index. Our findings suggest that sleep apnea may protect bone health.


The menopause transition is associated with decline in bone mineral density (BMD) and sleep quality. However, any relationship between these two factors remains controversial. This study explored the association between sleep apnea and femoral neck BMD in middle-aged women.


Participants (n = 1201) aged 45–69 years attending well-women visits at the National University Hospital, Singapore were recruited. Self-reported breathing discomfort and snoring, partner-witnessed apnea and snoring were assessed from the Pittsburgh Sleep Quality Index. Femoral neck BMD was assessed with dual-energy X-ray absorptiometry scan and classified into tertiles based on T-scores. Factors reported to affect sleep apnea and bone health in medical literature were potential covariates, p < 0.10. Multivariable ordinal regression analyses assessed associations between sleep measures and BMD. To further validate our findings, we analyzed four sleep apnea characteristics from the STOP questionnaire, a screening tool for sleep apnea. All analyses were performed using SPSS version 20.0.


Mean (SD) age of participants was 56.3 (6.2) years. Partner-witnessed apnea predicted higher BMD tertiles (OR per unit increase in severity 1.39, 95% CI [1.02, 1.89]), independent of age, ethnicity, diabetes, BMI, and handgrip strength. This was further corroborated by the STOP index (OR 1.45, 95% CI [1.07, 1.96]).


This study adds to the literature on sleep apnea and bone health in a non-Caucasian and younger population. Our findings support OSA-associated intermittent hypoxia protecting bone health.


Sleep apnea Bone mineral density 



We would like to thank our study participants and study coordinators, Eng Sok Kheng, Chua Seok Eng, Poon Peng Cheng, Ng Poh Lian, Zhang Xuan, Teo Yean Ling, Saw Myat Sabai, and Ho Kum Chue who assisted in the data compilation. We are thankful to Low Siew Leng and Tan Sze Yee, the staff of Orthopaedic Diagnostic Centre, who conducted all the DEXA scans for our participants. We acknowledge the contribution by Dr. Stephen Smagula in conducting the pre-study workshops and advising on the study design methodologies and analysis.

Compliance with ethical standards

The protocol was approved by the Domain Specific Review Board of National Healthcare Group, Singapore, and all participants provided written informed consent.

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Han Ying Tng
    • 1
  • Win Pa Pa Thu
    • 1
  • Susan Logan
    • 1
  • Izzuddin M. Aris
    • 1
  • Jane Cauley
    • 2
  • Eu Leong Yong
    • 1
    Email author
  1. 1.Department of Obstetrics and GynecologyNational University of SingaporeKent RidgeSingapore
  2. 2.Graduate School of Public Health, Department of EpidemiologyUniversity of PittsburghPittsburghUSA

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