Obstructive Sleep Apnea Increases The Risk Of Osteoporosis In Patients With Chronic Obstructive Pulmonary Disease

Objective: To clarify the risk associations of factors such as different severities of obstructive sleep apnea (OSA), age, gender, and comorbid underlying diseases with osteoporosis in patients with chronic obstructive pulmonary disease (COPD), and to provide evidence-based support for the precise prevention and management of osteoporosis in COPD patients complicated with OSA. Methods: This was a retrospective cohort study. A total of 305 COPD patients diagnosed at the Second Affiliated Hospital of Guangdong Medical University from January 2019 to December 2019 were enrolled, including 60 cases without OSA, 91 cases with mild OSA, 84 cases with moderate OSA, and 70 cases with severe OSA. Data were collected through the hospital’s electronic medical record system, and follow-up was conducted until June 2025 or until the patient was diagnosed with osteoporosis, lost to follow-up, or died. Univariate and multivariate logistic regression analyses were used to explore the associations of OSA severity and comorbid underlying diseases (hypertension, diabetes mellitus, coronary heart disease, cerebrovascular disease, dyslipidemia) with the risk of osteoporosis. Stratified analyses by age and gender were also performed. The statistical indicators included odds ratio (OR) and 95% confidence interval (95%CI), with a significance level of α=0.05. Results: Multivariate analysis showed that moderate and severe OSA were positively correlated with the risk of osteoporosis in COPD patients. Moderate OSA (multivariate OR=5.529, P=0.003) and severe OSA (multivariate OR=6.070, P=0.003) were independent risk factors for osteoporosis in COPD patients. Meanwhile, the study indicated that body mass index (BMI) (multivariate OR=0.391, P<0.001) and age (multivariate OR=1.063, P=0.018) of COPD patients were associated with the risk of osteoporosis. Mild OSA and other underlying diseases had no significant effects (all P>0.05). Age subgroup stratified analysis revealed that in the population aged >75 years, severe OSA (multivariate OR=6.321, P=0.044) had a significant impact on osteoporosis, and BMI (multivariate OR=0.348, P<0.001) and serum phosphorus level (multivariate OR=0.056, P=0.014) were negatively correlated with osteoporosis. In the population aged ≤75 years, neither moderate nor severe OSA showed statistical significance (both P>0.05). however, BMI (multivariate OR=0.365, P<0.001) still showed a negative correlation in this group, and coronary heart disease (multivariate OR=6.849, P=0.018) became an independent risk factor for this population. Gender subgroup stratified analysis demonstrated differences in risk factors for osteoporosis between male and female After adjustment, moderate OSA (multivariate OR=4.263, P=0.029), severe OSA (multivariate OR=4.759, P=0.030), BMI (multivariate OR=0.391, P<0.001), age (multivariate OR=1.108, P=0.004), and serum phosphorus level (multivariate OR=0.096, P=0.017) were significantly correlated with osteoporosis in male patients. In female patients, after adjustment, the associations of moderate OSA and severe OSA with osteoporosis were not statistically significant (both P>0.05). but BMI (multivariate OR=0.167, P=0.002) still had a significant negative correlation with osteoporosis. Conclusion: Moderate and severe OSA are significantly positively correlated with the risk of osteoporosis in COPD patients. Moderate and severe OSA have a more significant impact on osteoporosis in male patients, while severe OSA has a more notable effect in patients aged >75 years. It should also be noted that BMI is negatively correlated with osteoporosis in patients of all groups. In clinical practice, focus should be placed on male patients aged >75 years with moderate to severe OSA and COPD patients with excessively low BMI (the normal range for most adults is 18.5-23.9). Early bone mineral density screening and standardized OSA treatment should be implemented to reduce the risks of osteoporosis and fractures.