이공명외. 우리나라 18 세이상성인에서수면시간의길이와골밀도와의관련성 : 국민건강영양조사자료활용 2010 KJFP 는상반되게짧은수면시간과비교하여긴수면시간이골다공증의높은비교위험도를가진다는연구 12) 도있었으나국내에서는고령의여성들에서수면시간이낮은골밀도와연관이있다는연구외 13

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KJFPpISSN 2233-9019 eissn 2233-9116 Original Article 우리나라 18 세이상성인에서수면시간의길이와골밀도와의관련성 : 국민건강영양조사자료활용 2010 이공명, 황지혜, 서우정, 이미나, 김태성, 강희철 * 연세대학교의과대학가정의학교실 Association between sleep duration and bone

1 KJFPpISSN eissn Original Article 우리나라 18 세이상성인에서수면시간의길이와골밀도와의관련성 : 국민건강영양조사자료활용 2010 이공명, 황지혜, 서우정, 이미나, 김태성, 강희철 * 연세대학교의과대학가정의학교실 Association between sleep duration and bone mineral density density in Korean adults over 18years old: Based on the Korea National Health and Nutrition Examination Survey, 2010 Gong-Myung Lee, Ji-Hye Hwang, Woo-Jeong Seo, Mi-Na Lee, Tae-Sung Kim, Hee-Cheol Kang * Department of Family Medicine, College of Medicine, Yonsei University Background: Sleep duration is associated with many diseases, yet few studies have been performed on the association between sleep duration and bone mineral density(bmd) in Korea. In this study we investigated the association between sleep duration and bone mineral density in adults over 18 years of age. Methods: Subjects of this study were adults over 18 years of age who responded to a questionnaire on sleep duration and underwent BMD measurement by dual X-ray absorptiometry. Comprehensive data on the study sample was obtained from the Korean National Health and Nutrition Examination Survey(KHANES) conducted in Age- and sex-stratified multiple regression analyses were conducted with adjustment for possible confounding factors. Results: There was an inverse, dose-dependent association between sleep duration and BMD measured in the total femur, femur neck, lumbar spine and total bone in both women over 50 years of age and men between 30 and 49 years of age. Sex-stratified multiple regression analysis adjusted for age and body mass index revealed a negative correlation between sleep duration and BMD in the total femur and femur neck in both genders over 50 years of age, as well as in women between ages 30 and 49. Initial significance disappeared after adjustment for additional covariates including smoking, alcohol, and exercise. Conclusion: Significant variations in regional BMD with sleep duration were observed among women and men between ages 30 and 49. Prolonged sleep duration appears to be a risk factor for low bone mineral density. Thus, adequate sleep duration is important for preventing osteoporosis Keywords: sleep duration, bone mineral density, Osteoporosis 서론 을찾아보고자하는연구가이뤄지고있다. 건강습관관련인자는흡 연, 음주, 규칙적인운동, 음식의섭취가있으며건강상태관련은고 최근우리사회가빠르게고령화되면서골다공증의유병률이급속도로증가하고있다. 1999년 Cho.S.H 등의연구에서는국내 50세이상여성의요추골다공증유병률이 16.3% 였으나, 1) 2010년 Shin. C.S 등의조사에따르면골다공증유병률이 24.0% 로증가하였다. 2) 골다공증으로인한골절은사망률을높이는것으로알려져있어이를예방하기위하여원인및관련요소들에대한연구들이활발히이뤄지고있으며특히건강습관과건강상태등과관련하여위험요인 혈압, 당뇨병, 고지혈증등기저질환의이환여부가있다. 수면시간은다양한질환과연관된것으로알려져왔으며적절한수면을취하지못하였을때고혈압, 3) 관상동맥질환, 4) 당뇨병, 5, 6) 비만의 7, 8) 유병률증가와의관련성에관한보고및짧은수면시간이대사증후군발생의위험인자라고보고한연구도있었다. 9, 10) 최근에는수면시간과골다공증과의관련성에대하여조사한해외연구들이있다. 짧은수면시간이낮은골밀도와연관된다는연구, 11) 이와 Received February 27, 2015 Revised August 28, 2015 Accepted September 3, 2015 Corresponding Author Hee-Cheol Kang Tel: , Fax: kanghc@yuhs.ac Copyright 2015 The Korean Academy of Family Medicine This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited

2 이공명외. 우리나라 18 세이상성인에서수면시간의길이와골밀도와의관련성 : 국민건강영양조사자료활용 2010 KJFP 는상반되게짧은수면시간과비교하여긴수면시간이골다공증의높은비교위험도를가진다는연구 12) 도있었으나국내에서는고령의여성들에서수면시간이낮은골밀도와연관이있다는연구외 13) 에는수면시간과골다공증의관련성에관한연구를찾아보기힘들다. 이에본연구에서는제 5기기국민건강영양조사자료를이용하여 18세이상의성인을대상으로수면시간이골밀도에미치는영향을알아보고자하였으며수면시간이단일인자로서골다공증과관련있는지확인하고자했다. 활동을하는그룹으로정하였다. 골밀도 (bone mineral density) 는이중에너지 X선흡수계측법 (dual energy x-ray absorptionmetry) 을사용하여대퇴골전체, 대퇴골경부, 요추전체, 총골밀도를측정하였으며단위는 g/cm 2 로나타내었다. 혈액내 Vitamin D의경우 Institute of medicine criteria에따라혈액검사를통해측정된 25-hydroxy-vitamin D를 <12, 12~20, 20ng/mL < 으로구분하였다. 체질량지수는키 (cm) 와몸무게 (kg) 를이용하여몸무게를키의제곱으로나눈것으로정의하였다. 방법 3. 자료분석 국민건강영양조사는복합표본설계로구성된자료이므로분산추 1. 연구대상본연구의자료는제5기국민건강영양조사원시자료로서건강설문조사, 영양조사, 검진조사로구성되어있으며건강설문조사에포함된나이, 키, 체중, 체질량지수, 흡연, 음주, 활동량, 고혈압, 당뇨병, 이상지질혈증, 관절염의의사진단여부, 골다공증의가족력변수와검진조사에포함된골밀도검사변수, 혈액내비타민 D변수, 하루섭취칼슘량변수를이용하였다. 제5기 1차년도 (2010) 국민건강영양조사자료에포함된총 8958명중 18세이상이면서골밀도검사를시행한 6820명을대상으로하였으며그중수면시간을응답하였으나과거력상골절이있었던경우, 과거력상신장질환으로진단받은경우, 갑상선질환으로진단받은경우를제외한 6117 명을대상으로하였다. 2. 변수정의연령을 18세이상에서 29세이하 ( 연령 A군 ), 30세이상에서 49 세이하 ( 연령 B군 ), 50세이상 ( 연령 C군 ) 그룹으로구분하였으며, 14) 수면시간은평균수면시간 6시간미만, 6시간이상 7시간미만, 7시간이상 8시간미만, 8시간이상 9시간미만, 9시간이상 5개군으로나누었으며수면시간 6시간미만을수면시간이짧은군, 수면시간 9시간이상을수면시간이긴군으로정하였다. 혼란변수들을건강습관관련, 건강상태관련으로분류하였으며건강습관관련요인으로음주, 흡연평가, 신체활동, 하루섭취칼슘량, 건강상태관련요인은고혈압, 당뇨, 이상지질혈증, 관절염유병여부와골다공증가족력으로나눴다. 음주는고위험음주항목설문조사에따라거의매일음주한다고답한대상자를과도음주그룹으로, 흡연평가는평생흡연여부에대한설문조사에서평생 5갑 (100개비 ) 이상으로대답한군을현재흡연자로정하였다. 신체활동설문조사에서격렬한신체활동 1회 20분이상, 주 3일이상실천으로답하거나또는중등도신체활동 1회 30분이상, 주 5일이상실천한경우활발한신체 정층, 층화변수및표본가중치를부여하여분석하였다. 자료분석은 SAS version 9.2 통계프로그램을이용하였으며질병관리본부의국민건강영양조사원시자료이용지침에따라서가중치를사용하였으며연구대상자의기본특성에대하여남, 녀를나누어서연령그룹별로각변수들의특성에차이가있는지를보이기위해 ANOVA 와카이제곱검정을하여유의성을평가하였다. 수면시간을 6시간미만에서 9시간이상까지 5개의그룹으로분류하였을때수면시간이각각의부위별골밀도에영향을미치는지경향성을알아보기위해단일선형회귀분석을시행하여경향성을알아보았으며골밀도와연관된다른요인들에대해보정을한다중회귀분석을시행하였다. 모든통계적유의수준은 0.05로설정하였다. 결과 1. 연구대상의기본적특성 Table 1, 2는연구대상자들을성별, 연령군에따라서 18세이상 30세미만군 ( 연령 A군 ), 30세이상 50세미만군 ( 연령 B군 ), 50세이상군 ( 연령 C군 ) 으로나누어기본적인특징을비교한결과다. 남성군은평균수면시간이연령A군에서 7.09±0.15시간, 연령B군은 7.04±0.20 시간, 연령 C군은 7.12±0.27시간을보였으나통계적으로유의미한차이는없었다 (p-value =0.9697). 연령이증가할수록과도음주그룹에속하는비율이증가하는양상을보였으며현재흡연자의비율도연령 C군에서 84.16% 로가장높았다. 신체활동은연령B군에서가장활발하게신체활동을하는것으로나타났다. 체내혈중비타민 D의경우연령 C군에서 20ng/mL< 이상인군이타연령군에비하여 45.55% 로그비율이높았으며칼슘섭취량은연령 B군에서 ±14.4g으로타연령군에비하여높았다. 여성군의경우평균수면시간은연령 A군에서 7.41±0.08 시간, 연령 B군 7.22±0.13 시간, 연령 C군의경우 7.39±0.33시 241

3 KJFP Gong-Myung Lee, et al. Association between sleep duration and bone mineral density density in Korean adults over 18years old: Based on the Korea National Health and Nutrition Examination Survey, 2010 Table1. Baseline characteristics of male study subjects Characteristic 18-29y(n=351) 30-49y(n=1064) 50(n=1140) p-value Body composition Height(cm) ± ± ± 0.23 Weight(kg) 71.64± ± ± 0.38 Waist circumference(c m) 80.39± ± ± 0.32 Body mass index(kg/m 2 ) 23.45± ± ± 0.11 Social behaviors Heavy drinker Current smoker 27(9.26%) 172(57.51%) 111(10.96%) 848(82.06%) 137(18.38%) 927(84.16%) Regular exercise 220(69.23%) 823(76.93%) 858(75.79%) Sleep duration, Mean(h) 7.09± ± ± Serum vitamin D level(ng/ml) <12 88(23.40%) 160(16.38%) 190(16.21%) >20 190(55.30%) 73(21.30%) 528(48.74%) 376(34.88%) 433(38.23%) 517(45.55%) Daily calcium consumption(g) ± ± ± Comorbidity Hypertension 6(1.64%) 77(7.58%) 432(34.87%) Dyslipidemia 2(0.32%) 62(5.56%) 141(13.15%) Osteoarthritis/RA 3(1.30%) 19(1.63%) 96(7.36%) Diabetes mellitus 1(0.25%) 29(2.76%) 195(15.73%) Family Hx. of Osteoporosis * 9(3.41%) 158(14.70%) 122(13.85%) * family history of osteoporosis or own past history of traumatic fracture Vigorous exercise for more than 20 minutes at least three times a week or moderate exercise or walking for more than 30minutes at least five times a week Those who answered to questionnaire as almost daily drinking Anaylsis of variance(anova) for continuous variables and chi-square test for categorical variables Table 2. Baseline characteristics of females Characteristic 18-29y(n=494) 30-49y(n=1291) 50(n=1385) p-value Body composition Height(cm) ± ± ± 0.2 Weight(kg) Waist circumference(cm) 55.67± ± ± ± ± ± Body mass index(kg/m 2 ) 21.38± ± ± 0.11 Health behaviors Heavy drinker 8(1.78%) 25(3.28%) 10(1.53%) Current smoker 69(16.04%) 137(12.23%) 89(8.16%) Regular exercise 373(81.62%) 1032(80.31%) 1076(79.87%) Sleep duration, Mean(h) 7.41± ± ± Serum vitamin D level(ng/ml) <12 188(36.25%) 334(26.91%) 359(23.88%) >20 237(49.37%) 69(14.38%) 728(54.26%) 229(18.83%) 616(45.32%) 410(30.80%) Daily calcium consumption(g) 459.1± ± ±10.46 Comorbidity Hypertension 0(. ) 43(3.59%) 553(42.06%) Dyslipidemia 0(. ) 28(2.09%) 251(18.69%) Osteoarthritis/RA 3(0.47%) 42(3.77%) 465(34.55%) Diabetes mellitus 3(0.61%) 27(2.13) 153(11.69%) Family Hx. of Osteoporosis * 11(2.84%) 254(21.21%) 220(16.14%) * family history of osteoporosis or own past history of traumatic fracture Vigorous exercise for more than 20 minutes at least three times a week or moderate exercise or walking for more than 30minutes at least five times a week Those who answered to questionnaire as almost daily drinking Anaylsis of variance(anova) for continuous variables and chi-square test for categorical variables 242

4 이공명외. 우리나라 18 세이상성인에서수면시간의길이와골밀도와의관련성 : 국민건강영양조사자료활용 2010 KJFP Table 3. The relationships between sleep duration and regional BMD by gender(male) and age Male, 18~29 y(n=390) <6(n=31) 6~6.9(n=94) 7~7.9(n=94) 8~8.9(n=73) 9(n=38) Male 30~49y(n=1176) <6(n=94) 6~6.9(n=332) 7~7.9(n=330) 8~8.9(n=199) 9(n=48) Male 50y(n=1203) <6(n=195) 6~6.9(n=239) 7~7.9(n=284) 8~8.9(n=265) 9(n=95) BMD(g/cm 2 ) Lumbar Total bone 1.005± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ( * ): number of study subjects BMD : bone mineral density Data were calculated by simple linear regression analysis, values are presented as meanstandard error 간을보였으며통계적으로유의미한차이는없었다 (p-value = ). 음주하는비율은연령 B 군에서 3.28% 로다른연령군에 비해높게나타났으며, 현재흡연자는연령 A 군에서 16.04% 로연 시간이증가할수록골밀도의유의미한감소를보였으며 ( 대퇴골전 체, P=0.0033; 대퇴골경부, P=0.0091; 요추, P=0.0169), 연령 B 군의경우요추부에서유의미한감소를보였다 (Table 4). 령 C 군의 8.16% 에비하여높았다. 혈중비타민 D 의경우연령 C 군에서결핍되지않은군이 30.80% 로높았으며칼슘섭취량은연령 B군에서 ±11.95g로다른연령군에비하여높았다. 남녀성별군모두고혈압, 이상지질혈증, 당뇨병, 골관절염등관련질환이연령군이높아질수록이환된상태가높은것으로나타났다 (P= ). 3. 다중선형회귀분석을통한수면시간과골밀도수치와의관련성 Table 5는혼란변수들을보정하여수면시간과골밀도와의관련성을본것으로연령과체질량지수를보정한 model 1의경우남성연령 C군에서대퇴골전체, 대퇴골경부, 총골밀도에서수면시간과골밀도간의역관계를볼수있었으며여성은연령 B군에서대 퇴골전체, 대퇴골경부, 요추, 총골밀도에서또, 연령 C 군의경우 2. 수면시간과골밀도수치와의단순선형관련성 Table 3, 4는성별과연령군에따른수면시간과골밀도와의상관관계를분석한결과이다. 남성의경우연령 B군에서대퇴골전체, 대퇴골경부, 요추, 총골밀도에서수면시간이증가할수록유의미하게골밀도가감소하는경향을보였으며 ( 대퇴골전체, P=0.0030; 대퇴골경부, P=0.0003; 요추, P=0.0179), 연령 C군에서는대퇴골경부에서수면시간증가에따라유의미한골밀도감소를보였다 (Table 3). 여성의경우연령 C군에서대퇴골전체와경부, 요추부에서수면 대퇴골전체, 대퇴골경부, 요추부에서수면시간과골밀도의역관계를볼수있었다. 이러한수면시간과골밀도와의음의상관관계는 model 2에서관련질환들인고혈압, 당뇨병, 이상지질혈증, 관절염의과거력, 골다공증의가족력에대한보정을시행후에도남성연령 C군과여성연령 B, C군모두에서유의한관련성을확인할수있었다. Model 3에서는건강관련습관인흡연, 음주, 신체활동여부에대하여추가보정을하였고남성연령 C군과여성연령 B, C군에서의유의한경향성이사라졌으나, 남성연령 B군에서는대퇴골전체, 대퇴골경부, 요추부위에서추가보정을시행후에골 243

5 KJFP Gong-Myung Lee, et al. Association between sleep duration and bone mineral density density in Korean adults over 18years old: Based on the Korea National Health and Nutrition Examination Survey, 2010 Table 4. The relationships between sleep duration and regional BMD by gender(female) and age Female, 18~29y(n=528) <6(n=35) 6~6.9(n=91) 7~7.9(n=121) 8~8.9(n=113) 9(n=68) Female, 30~49y(n=1356) <6(n=96) 6~6.9(n=283) 7~7.9(n=421) 8~8.9(n=302) 9(n=90) Female, 50(n=1464) <6(n=330) 6~6.9(n=322) 7~7.9(n=327) 8~8.9(n=252) 9(n=104) BMD(g/cm 2 ) Lumbar Total bone 0.911± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ( * ): number of study subjects BMD : bone mineral density Data were calculated by simple linear regression analysis, values are presented as meanstandard error 밀도와수면시간의역관계의관련성을확인할수있었다 ( 대퇴골경 부, Β= , P=0.0421; 요추, Β= , P=0.0493; 총 골밀도, Β= , P=0.0391) (Table 5). 자를보정시관련성이사라지게된것은남성연령 C 군의경우수 면시간보다위의인자들이골다공증에더큰영향을미치고있는것 이기때문으로생각된다 (model 2, OR =1.055, P=0.0006). 4. 로지스틱회귀분석을통한수면시간에따른골다공증유병위험도 Table 6은남, 녀 50세이상의연령 C군에서수면시간에따른골다공증유병위험도를비교한것으로 50세이하의연령군에서는골다공증유병자의수가충분하지않아추가적인분석을할수없었다. 수면시간이 6시간미만인군과비교하여 9시간이상수면군에서골다공증유병위험도가 1.158(male, OR =1.158, = ), 1.553으로유의하게높게나타났다 (female, OR =1.553, = ). Table 7에서는남, 녀 50세이상의연령 C 군에서혼란변수를보정한후수면시간과골다공증이환율간의관계를비교하였다. 그결과남성에서는수면시간이길수록단계별로연령, 체질량지수, 고혈압, 당뇨병, 이상지질혈증, 관절염의과거력, 골다공증의가족력에대한보정을시행후에도수면시간과골다공증의관련성이유의함을보였으나여성의경우보정을시행하자유의하지않은결과가도출되었다. 남성에서건강관련습관인흡연, 음주, 신체활동, 일일칼슘섭취량, 혈액내비타민 D등의인 고찰본연구에서는제 5기국민건강영양조사자료를이용하여하루평균수면시간과골밀도와의관계를통하여수면시간과골다공증의관련성을확인한결과남성연령 B, C군과여성연령 B, C군에서연령, 체질량지수, 고혈압, 당뇨병, 이상지질혈증, 관절염, 골다공증가족력을보정한경우에서수면시간과골밀도와의음의상관관계를확인할수있었다. 특히남성연령 B군에서는건강관련습관인흡연, 음주, 신체활동여부에대하여추가보정후에대퇴골전체, 대퇴골경부, 요추부위에서골밀도와수면시간의역관계의관련성을확인할수있었다. 그동안여러가지연구를통하여수면시간과골밀도와의관련성이보고되었다. 일본에서는짧은수면시간과비교하여긴수면시간이골다공증의높은비교위험도를가진다는연구도있었고 12) 국내에서는 50세이상의고령의여성들에서만긴수면시간이낮은골 244

6 이공명외. 우리나라 18 세이상성인에서수면시간의길이와골밀도와의관련성 : 국민건강영양조사자료활용 2010 KJFP Table 5. Multi-variable adjusted analysis for the association between sleep duration on BMD stratified by gender and age* Variable Unadjusted Model 1 Model 2 Model 3 β p-value β p-value β p-value β p-value Female, 18-29y Female, 30-49y Female, 50y Male, 18-29y Male, 30-49y Male, 50y BMD: bone mineral density * Standardized regression of coefficients of total femur, femur neck, lumbar spine, and total BMD with sleep duration were calculated by multiple linear regression analysis after adjusting for confounding factors. Model 1: age and body mass index. Model 2: age, body mass index, hypertension, diabetes mellitus, dyslipidemia, past history of osteoarthritis/rheumatoid arthritis, and family history of osteoporosis. Model 3: age, body mass index, hypertension, diabetes mellitus, dyslipidemia, past history of osteoarthritis/rheumatoid arthritis, family history of osteoporosis, daily calcium intake, serum vitamin D level, smoking status, drinking status, and exercise habits. Table 6. The relationships between sleep duration and Oste-oporosis 밀도와연관이있다는연구가있었다. 13) 본연구에서는이전의연구 <6 6~6.9 7~7.9 8~8.9 9 Male, 50(n=1203) (95% CI) Osteoporosis Odds ratio Ref (0.197, 0.841) (0.32, 1.582) (0.452, 2.1) (0.432, 3.102) Female, 50, menopause (n=1464) (95% CI) Ref (0.476, 1.179) (0.593, 1.275) (0.389, 0.99) (0.946, 2.547) 결과와같이수면시간과골밀도와의역의관련성을확인할수있었으며이전의연구와비교하여남성과여성연령 B군에서도수면시간이길어짐에따라골밀도가감소하는경향을확인할수있었다는차별점이있다. 성별및연령군에따라골밀도와수면시간의관련성이차이를보였는데연령 A군의경우수면시간이길수록성장호르몬으로인한최대골량증가에도움이된다는연구가 15) 있으나최대골량이감소하기시작하는 30세이후의연령군의경우성장호르몬이높을수 * Gtoup of Sleep duration less than 6hours was compared with other sleep duration groups 록골밀도의감소를가져온다는연구도있다. 16) 따라서, 30 세이상 의연령군에서수면시간이증가함에따라골밀도가감소하는원인 은다른접근이필요하며본연구에서는다음의두가지가정을제 245

7 KJFP Gong-Myung Lee, et al. Association between sleep duration and bone mineral density density in Korean adults over 18years old: Based on the Korea National Health and Nutrition Examination Survey, 2010 Table 7. Odds ratio and 95% confidence intervals for the Osteoporosis according to prolonged sleep duration Unadjusted Model 1 Model 2 Model 3 OR OR OR OR P value P value P value (95% CI) (95% CI) (95% CI) (95% CI) Male, 50y (1.012, 1.14) (1.021, 1.076) (1.023, 1.089) (0.813, 1.351) Female, 50y (1.005, 1.037) (0.992, 1.035) (0.991, 1.033) (0.89, 1.257) Model 1: age and body mass index. Model 2: age, body mass index, hypertension, diabetes mellitus, dyslipidemia, past history of osteoarthritis/rheumatoid arthritis, and family history of osteoporosis. Model 3: age, body mass index, hypertension, diabetes mellitus, dyslipidemia, past history of osteoarthritis/rheumatoid arthritis, family history of osteoporosis, daily calcium intake, serum vitamin D level, smoking status, drinking status, and exercise habit P value 시하고자한다. 첫번째로연령군이증가할수록신체활동의감소로인한골밀도의감소다. 17, 18) 긴수면시간으로인하여신체활동의감소, 특히뼈에하중이가해지는시간이짧아질수록골량의감소가유발될가능성이높다는것이기때문이다. 19) 두번째로수면시간의증가로인한체내에스트로겐의감소다. 에스트로겐은골다공증을예방해주는호르몬으로알려져있고, Cummings 등 20) 은짧은수면시간이높은혈중에스트로겐과연관된다는연구를보고한바있다. 또, 한연구에서는야간에빛에노출되는것이혈중에스트로겐의농도를상승시킨다는보고도있었다. 21) 이러한원인들로인하여본연구에서와같이 30세이상의연령군에서부위별로수면시간이길수록골밀도의감소가관찰된이유가설명가능할것이다. 본연구의한계점은연령별수면시간에따른골밀도의연관성을찾아본단면적연구이므로수면시간의길이가현재의골밀도로정확히반영되었다할수없다는점이다. 또, 낮잠과같은야간이외의수면시간에대한고려가이뤄지지않았다는점이다. 뿐만아니라, 여성들에서폐경여부에대한고려가이뤄지지않은점도한계점이라하겠다. 마지막으로추후수면시간이같은경우에수면의질에따른골밀도와수면시간과골밀도의관련성에관한연구가추가로이뤄질필요가있을것으로사료된다. 요약 중에너지 X선흡수계측법 (dual energy x-ray absorptionmetry) 을사용하여골밀도수치를측정한성인남성 2769명, 여성 3348명을대상으로하였으며연령군을 29세이하의 A군, 30에서 49세의 B군, 50세이상의 C군으로구분하였으며각연령군에서수면시간의길이에따른골밀도의변화를확인하기위하여다중회귀분석을사용하였다. 결과 : 남성연령 B군과여성연령 C군에서수면시간의길이와총골밀도, 대퇴골전체, 대퇴골경부, 요추부골밀도가유의미한역관계를보였으며남성연령 C군의대퇴골경부, 여성연령 B군의요추부에서도연관성이관찰되었다. 다중선형회귀분석시남녀연령 C군과여성연령 B군의대퇴골전체, 대퇴골경부의골밀도와수면시간은연령, 체질량지수, 고혈압, 당뇨병, 이상지질혈증, 관절염, 골다공증가족력을보정한경우에서만의미가유의미한연관성을보였으며흡연, 음주, 신체활동을추가로보정한모델에서남성연령 B군의요추부와대퇴골경부, 총골밀도에서수면시간과유의미한역관계가관찰되었다 ( 요추, Β= , P=0.0493; 대퇴골경부, Β= , P=0.0421; 총골밀도, Β= , P=0.0391). 고찰 : 50세이상뿐아니라남녀 30세이상의연령군에서도수면시간증가에따른부위별골밀도의유의한감소를확인할수있었다. 연구배경 : 수면시간은다양한대사질환들과연관된것으로알려져왔으나골다공증과의관련성은아직정확히알려져있지않다. 최근해외에서는수면과골밀도수치사이의연구가활발한상태이나국내에서는아직그연구가드문상태로본연구에서는한국성인들에서수면시간과골밀도와의연관성을알아보고자하였다. 방법 : 본연구에서는제 5기 1차년도 (2010) 국민건강영양조사자료에서만 18세이상성인중수면시간설문조사에응답하였고이 중심단어 : 수면시간, 골밀도, 골다공증 REFERENCES 1. CHO S, HWANG Y, LEE J, Choi Y, Cho S. Prevalance of osteoporosis based on bone density measurement in Korean women Korean J Obstet Gynecol. 1999;42: Shin CS, Choi HJ, Kim MJ, Kim JT, Yu SH, Koo BK, et al. Prevalence and risk factors of osteoporosis in Korea: a community

8 이공명외. 우리나라 18 세이상성인에서수면시간의길이와골밀도와의관련성 : 국민건강영양조사자료활용 2010 KJFP based cohort study with lumbar spine and hip bone mineral density. Bone. 2010;47(2): Gottlieb DJ, Redline S, Nieto FJ, Baldwin CM, Newman AB, Resnick HE, et al. Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep. 2006;29(8): Ayas NT, White DP, Manson JE, Stampfer MJ, Speizer FE, Malhotra A, et al. A prospective study of sleep duration and coronary heart disease in women. Archives of internal medicine. 2003;163(2): Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, Baldwin CM, et al. Association of sleep time with diabetes mellitus and impaired glucose tolerance. Archives of internal medicine. 2005;165(8): Yaggi HK, Araujo AB, McKinlay JB. Sleep duration as a risk factor for the development of type 2 diabetes. Diabetes care. 2006;29(3): Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS medicine. 2004;1(3):e Chaput JP, Despres JP, Bouchard C, Tremblay A. Short sleep duration is associated with reduced leptin levels and increased adiposity: Results from the Quebec family study. Obesity. 2007;15(1): Wu MC, Yang YC, Wu JS, Wang RH, Lu FH, Chang CJ. Short sleep duration associated with a higher prevalence of metabolic syndrome in an apparently healthy population. Preventive medicine. 2012;55(4): Choi JK, Kim MY, Kim JK, Park JK, Oh SS, Koh SB, et al. Association between short sleep duration and high incidence of metabolic syndrome in midlife women. The Tohoku journal of experimental medicine. 2011;225(3): Fu X, Zhao X, Lu H, Jiang F, Ma X, Zhu S. Association between sleep duration and bone mineral density in Chinese women. Bone. 2011;49(5): Kobayashi D, Takahashi O, Deshpande GA, Shimbo T, Fukui T. Association between osteoporosis and sleep duration in healthy middle-aged and elderly adults: a large-scale, cross-sectional study in Japan. Sleep & breathing = Schlaf & Atmung. 2012;16(2): Kim N, Choi HR, Kim SW, Kim BS, Won CW, Kim SY. Association between Bone Mineral Density and Sleep Duration in the Korean Elderly Population. Korean journal of family medicine. 2014;35(2): Compston JE. Sex steroids and bone. Physiological reviews. 2001;81(1): Mora S, Gilsanz V. Establishment of peak bone mass. Endocrinology and metabolism clinics of North America. 2003;32(1): Fall C, Hindmarsh P, Dennison E, Kellingray S, Barker D, Cooper C. Programming of growth hormone secretion and bone mineral density in elderly men: a hypothesis. The Journal of clinical endocrinology and metabolism. 1998;83(1): Bonaiuti D, Shea B, Iovine R, Negrini S, Robinson V, Kemper HC, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. The Cochrane database of systematic reviews. 2002(3):CD Friedlander AL, Genant HK, Sadowsky S, Byl NN, Gluer CC. A two-year program of aerobics and weight training enhances bone mineral density of young women. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1995;10(4): Slemenda CW. Body composition and skeletal density-mechanical loading or something more? The Journal of clinical endocrinology and metabolism. 1995;80(6): Cummings SR, Browner WS, Bauer D, Stone K, Ensrud K, Jamal S, et al. Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of Osteoporotic Fractures Research Group. The New England journal of medicine. 1998;339(11): Verkasalo PK, Lillberg K, Stevens RG, Hublin C, Partinen M, Koskenvuo M, et al. Sleep duration and breast cancer: a prospective cohort study. Cancer research. 2005;65(20):

한국성인에서초기황반변성질환과 연관된위험요인연구

한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -