OBSTRUCTIVE sleep apnea was independently associated with higher odds of nontraumatic fracture history among older adults.
A community-based study of 5,519 adults found an age dependent relationship between obstructive sleep apnea and self-reported fracture history, with the strongest signal in older participants. Investigators also observed that poor sleep quality may further shape fracture patterns among older adults with obstructive sleep apnea.
Obstructive Sleep Apnea and Age Dependent Fracture History
Participants were recruited via multistage probability sampling between 2021 and 2023 in Guangdong Province, China, and completed sleep assessment using a wearable type IV monitor. Obstructive sleep apnea was defined by an oxygen desaturation index of at least 5 events per hour. Fracture history was self-reported based on physician diagnoses, and poor sleep quality was defined as a Pittsburgh Sleep Quality Index score greater than 5.
Overall, the mean age was 52.7 years. The prevalence of obstructive sleep apnea was 44.5%, and 13% of participants reported a history of fractures. When grouped by age tertiles, obstructive sleep apnea was not associated with self-reported history of fractures among adults aged 18 to 47 years. In contrast, the association emerged in adults aged 48 to 58 years and was most pronounced among adults aged 59 to 91 years. In the oldest group, obstructive sleep apnea was significantly associated with self-reported previous nontraumatic fractures, with an odds ratio of 3.68 (95% CI: 1.79 to 7.57).
Poor Sleep Quality and Traumatic Fractures in Older Adults
In adults aged 59 to 91 years, participants with both obstructive sleep apnea and poor sleep quality had higher odds of self-reported previous traumatic fractures compared with those with obstructive sleep apnea alone (OR 1.64, 95% CI: 1.02 to 2.65). The authors also reported significant interactions involving obstructive sleep apnea and age, as well as obstructive sleep apnea and alcohol consumption, in relation to self-reported fracture history.
Taken together, the findings suggest obstructive sleep apnea may be a marker of fracture vulnerability that becomes more clinically meaningful with age, while sleep quality and drinking patterns may further modify risk in older adults.
Reference: Chen J et al. Age-dependent association between obstructive sleep apnea and self-reported history of fractures: a community-based study. BMC Public Health. 2025;25(1):4291.
