Obstructive sleep apnea and objective short sleep duration are independently associated with the risk of serum vitamin D deficiency

PLoS One. 2017 Jul 7;12(7):e0180901. doi: 10.1371/journal.pone.0180901. eCollection 2017.


Background: Studies demonstrate an association between vitamin D (25(OH)D) deficiency and sleep disturbances, such as obstructive sleep apnea (OSA) and short sleep duration. However, to date, no studies have concurrently and objectively evaluated the effect of these factors on 25(OH)D.

Objectives: To evaluate whether OSA and objective short sleep duration are independently associated with reduced 25(OH)D in an adult population sample.

Methods: A cross-sectional study included 657 individuals from the city of Sao Paulo, Brazil, as part of the ERA project. Participants fulfilled questionnaires and underwent clinical evaluation, polysomnography and blood sample collection for 25(OH)D quantification. OSA was classified into three categories (mild, moderate and severe). The risk of 25(OH)D deficiency was considered as levels<30 ng/mL. Short sleep duration was defined as total sleep time<6 hours.

Results: The risk of 25(OH)D deficiency was observed in 59.5% of the sample, affecting more individuals of the female gender, obese, with African American ethnicity, and those that were smokers, sedentary and presented hypertension and diabetes. In the final logistic model adjusted for age, gender, ethnicity, obesity, smoking, hypertension, diabetes, sedentary lifestyle, seasonality and creatinine serum levels, both OSA and short sleep duration showed significant independent associations with the risk of 25(OH)D deficiency (moderate OSA: OR for 25(OH)D<30 = 2.21, 95% CI: 1.35-3.64, p<0.01; severe OSA: OR for 25(OH)D<30 = 1.78, 95% CI: 1.06-3.00, p = 0.03; short sleep duration: OR for 25(OH)D<30 = 1.61, 95% CI: 1.15-2.26, p = 0.01). After a subgroup analysis, similar results were observed only in participants ≥50 years.

Conclusion: OSA and short sleep duration are independently associated with the risk of 25(OH)D deficiency in an adult population. Age-related changes in vitamin D metabolism and the frequency of sleep disorders may be involved in these associations. Future studies exploring whether 25(OH)D levels may modulate OSA and sleep curtailment-related outcomes are needed.

MeSH terms

  • Adult
  • Black People
  • Cross-Sectional Studies
  • Diabetes Mellitus / physiopathology
  • Female
  • Humans
  • Hypertension / physiopathology
  • Male
  • Middle Aged
  • Obesity / physiopathology
  • Polysomnography
  • Risk Factors
  • Sedentary Behavior
  • Severity of Illness Index
  • Sleep / physiology
  • Sleep Apnea, Obstructive / blood
  • Sleep Apnea, Obstructive / complications*
  • Sleep Apnea, Obstructive / ethnology
  • Sleep Apnea, Obstructive / physiopathology
  • Sleep Wake Disorders / blood
  • Sleep Wake Disorders / complications*
  • Sleep Wake Disorders / ethnology
  • Sleep Wake Disorders / physiopathology
  • Smoking / physiopathology
  • Surveys and Questionnaires
  • Vitamin D / blood*
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / complications*
  • Vitamin D Deficiency / ethnology
  • Vitamin D Deficiency / physiopathology
  • White People


  • Vitamin D

Grants and funding

The support of Fundação de Amparo à Pesquisa do Estado de São Paulo (#2014/15259-2 to CH) was a personal PhD fellowships, and the #98/14303-3 is already finished. The duration of both are demonstrated in the attachments and also avaliable in the following links: (http://www.bv.fapesp.br/pt/pesquisa/?q=&count=10&format=detailed_with_publications&index=&q2=&selected_facets=pesquisadores_exact:%22Camila%20Hirotsu%22&sort=-data_inicio; http://www.bv.fapesp.br/pt/auxilios/29301/center-for-sleep-studies/) Associação Fundo de Incentivo à Pesquisa (AFIP) is a private philanthropic non- profitable organization that has purchased reagents for the performance of the study. The sponsors had no role in the study design, data collection, and analysis, or in the manuscript writing.