title: Association between Sleep Duration, Insomnia Symptoms and Bone Mineral Density in Older Boston Puerto Rican Adults.
abstract: OBJECTIVE
  To examine the association between sleep patterns (sleep duration and insomnia symptoms) and total and regional bone mineral density (BMD) among older Boston Puerto Rican adults.
  
  
  METHODS
  We conducted a cross-sectional study including 750 Puerto Rican adults, aged 47-79 y living in Massachusetts. BMD at 3 hip sites and the lumbar spine were measured using dual-energy X-ray absorptiometry. Sleep duration (≤5 h, 6 h, 7 h, 8 h, or ≥9 h/d) and insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awaking, and non-restorative sleep) were assessed by a questionnaire. Multivariable regression was used to examine sex-specific associations between sleep duration, insomnia symptoms and BMD adjusting for standard confounders and covariates.
  
  
  RESULTS
  Men who slept ≥9h/d had significantly lower femoral neck BMD, relative to those reporting 8 h/d sleep, after adjusting for age, education level, smoking, physical activity, depressive symptomatology, comorbidity and serum vitamin D concentration. This association was attenuated and lost significance after further adjustment for urinary cortisol and serum inflammation biomarkers. In contrast, the association between sleep duration and BMD was not significant in women. Further, we did not find any significant associations between insomnia symptoms and BMD in men or women.
  
  
  CONCLUSIONS
  Our study does not support the hypothesis that shorter sleep duration and insomnia symptoms are associated with lower BMD levels in older adults. However, our results should be interpreted with caution. Future studies with larger sample size, objective assessment of sleep pattern, and prospective design are needed before a conclusion regarding sleep and BMD can be reached.
authors.affiliation: Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/ Peking Union Medical College, Beijing, China.
authors.forename: Jinya
authors.initials: J
authors.lastname: Niu
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Shivani
authors.initials: S
authors.lastname: Sahni
authors.affiliation: Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/ Peking Union Medical College, Beijing, China.
authors.forename: Susu
authors.initials: S
authors.lastname: Liao
authors.affiliation: Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Boston, Massachusetts, United States of America.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Tucker
authors.affiliation: Bone Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston Massachusetts, United States of America.
authors.forename: Bess
authors.initials: B
authors.lastname: Dawson-Hughes
authors.affiliation: Department of Nutritional Science, The Pennsylvania State University, University Park, Pennsylvania, United States of America.
authors.forename: Xiang
authors.initials: X
authors.lastname: Gao
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D015519:Bone Density; D001900:Boston / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D005272:Femur Neck / Q000737:chemistry; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D018836:Inflammation Mediators / Q000097:blood; D008159:Lumbar Vertebrae / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000032:analysis; D010024:Osteoporosis / Q000208:ethnology*; D011647:Puerto Rico / Q000208:ethnology; D012737:Sex Factors; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000208:ethnology*; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013997:Time Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D018836:Inflammation Mediators; D008903:Minerals; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D006854:Hydrocortisone