Sleep apnea and risk of pneumonia: a nationwide population-based study

Su, Vin‐Cent; Liu, Chia Jen; Wang, Hsin Kai; Wu, Li Hua; Chang, Shi Chuan; Perng, Diahn Warng; Su, Wei; Chen, Yuh Min; Lin, E.; Chen, Tzeng Ji; Chou, Kun-Ta

doi:10.1503/cmaj.131547

Cited by 129 publications

(120 citation statements)

References 29 publications

(23 reference statements)

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“…Although the study's main outcome (a broad composite of variables associated with post-operative mortality and a range of post-operative complications) showed no discrepancy between the group with excessive SDB and the group with a normal or near-normal SDB, this was not true of the incidence of sepsis and pneumonia, which were higher, particularly in the untreated forms of moderate to severe sleep apnoea. This association between sleep apnoea and various infections, already demonstrated by other previous studies [4,6,7], emphasises the importance of moving beyond an exclusive focus on the analysis of the cardiovascular impact of sleep apnoea (even in patients with a high cardiovascular risk, as in the study in question) and exploring other possibilities in which SDB could have potentially preventable or treatable consequences.There is a sufficiently plausible biological explanation for an increase in the number of post-operative infectious complications in patients with sleep apnoea. The coordination between respiration and swallowing…”

supporting

confidence: 61%

“…It therefore seems logical to suppose that excessive SDB could also be associated with the incidence, severity and prognosis of other noncardiovascular diseases, even in patients with a high cardiovascular risk. Along these lines, some studies in recent years have examined the association between sleep apnoea and other less investigated diseases, such as autoimmune diseases [2], cancer [3] and various infectious diseases [4].In the current issue of the European Respiratory Journal, RUPPRECHT et al [5] publish the results of a study that examined a group of patients with high cardiovascular risk who had recently undergone elective coronary bypass graft surgery (CABG), to analyse the impact of pre-operative excessive SDB on parameters, such as the incidence of respiratory infections and complications, which are not exclusively cardiovascular but are extremely important in the immediate post-operative period. Although the study's main outcome (a broad composite of variables associated with post-operative mortality and a range of post-operative complications) showed no discrepancy between the group with excessive SDB and the group with a normal or near-normal SDB, this was not true of the incidence of sepsis and pneumonia, which were higher, particularly in the untreated forms of moderate to severe sleep apnoea.…”

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confidence: 99%

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confidence: 99%

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Sleep apnoea and risk of post-operative infection: beyond cardiovascular impact

Martínez‐García

Chiner

2017

Eur Respir J

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Recent decades have seen the publication of numerous studies on the association between excessive sleep disordered breathing (SDB), particularly sleep apnoea, and an increase in cardiovascular morbidity and mortality. These studies have used a wide range of methodologies and criteria for patient inclusion. The results have been diverse, depending on the type of cardiovascular event or risk factor investigated, the patients' cardiovascular risk, the severity or type of the SDB, and the analysis of the primary and secondary prevention of cardiovascular events [1].Sleep apnoea is a disease capable of activating (mainly via intermittent hypoxaemia and sleep fragmentation and their consequences) several pathophysiological mechanisms not exclusive to cardiovascular disease, such as sympathetic hyperactivity, pro-inflammatory state, hypercoagulability, oxidative stress, endothelial dysfunction and immune dysfunction [1]. It therefore seems logical to suppose that excessive SDB could also be associated with the incidence, severity and prognosis of other noncardiovascular diseases, even in patients with a high cardiovascular risk. Along these lines, some studies in recent years have examined the association between sleep apnoea and other less investigated diseases, such as autoimmune diseases [2], cancer [3] and various infectious diseases [4].In the current issue of the European Respiratory Journal, RUPPRECHT et al. [5] publish the results of a study that examined a group of patients with high cardiovascular risk who had recently undergone elective coronary bypass graft surgery (CABG), to analyse the impact of pre-operative excessive SDB on parameters, such as the incidence of respiratory infections and complications, which are not exclusively cardiovascular but are extremely important in the immediate post-operative period. Although the study's main outcome (a broad composite of variables associated with post-operative mortality and a range of post-operative complications) showed no discrepancy between the group with excessive SDB and the group with a normal or near-normal SDB, this was not true of the incidence of sepsis and pneumonia, which were higher, particularly in the untreated forms of moderate to severe sleep apnoea. This association between sleep apnoea and various infections, already demonstrated by other previous studies [4,6,7], emphasises the importance of moving beyond an exclusive focus on the analysis of the cardiovascular impact of sleep apnoea (even in patients with a high cardiovascular risk, as in the study in question) and exploring other possibilities in which SDB could have potentially preventable or treatable consequences.There is a sufficiently plausible biological explanation for an increase in the number of post-operative infectious complications in patients with sleep apnoea. The coordination between respiration and swallowing

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supporting

confidence: 61%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Sleep apnoea and risk of post-operative infection: beyond cardiovascular impact

Martínez‐García

Chiner

2017

Eur Respir J

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“…In this study, we enrolled adult patients (aged 20 years and older) who had newly diagnosed sleep apnea (International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 780.51, 780.53, 780.57) during 2000 to 2010 as the study cohort (sleep apnea cohort). 13 The date of enrollment was defined as the date when sleep apnea was initially diagnosed. An age-, sex-, monthly income-, and urbanization-matched group of patients who did not have sleep apnea served as the control group and were randomly selected from the same data sets.…”

Section: Study Sample and Controlmentioning

confidence: 99%

Sleep Apnea and Risk of Panic Disorder

Chen

Lin

et al. 2015

The Annals of Family Medicine

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PURPOSE Epidemiological studies have identified a trend in the development of depressive and anxiety disorders following a diagnosis of sleep apnea. The relationship between sleep apnea and subsequent panic disorder, however, remains unclear.METHODS Using a nationwide database, the Taiwan National Health Insurance Research Database, patients with sleep apnea and age-, sex-, income-, and urbanization-matched control patients who did not have sleep apnea were enrolled between 2000 and 2010. Patients with a prior diagnosis of panic disorder before enrollment were excluded. The 2 cohorts were observed until December 31, 2010. The primary endpoint was occurrence of newly diagnosed panic disorder.RESULTS A total of 8,704 sleep apnea patients and 34,792 control patients were enrolled. Of the 43,496 patients, 263 (0.60%) suffered from panic disorder during a mean follow-up period of 3.92 years, including 117 (1.34%) from the sleep apnea cohort and 146 (0.42%) from the control group. The Kaplan-Meier analysis revealed a predisposition of patients with sleep apnea to develop panic disorder (log-rank test, P <.001). After multivariate adjustment, the hazard ratio for subsequent panic disorder among the sleep apnea patients was 2.17 (95% confidence interval, 1.68-2.81; P <.001).CONCLUSIONS Sleep apnea appears to confer a higher risk for future development of panic disorder. INTRODUCTIONO bstructive sleep apnea is a common disorder characterized by repeated episodes of apnea and hypopnea during sleep owing to complete or partial collapse of the upper airway.1 Subsequent to apnea/hypopnea, patients with sleep apnea will be awakened by the resulting hypoxemia so that they can resume breathing. Some patients may awake up feeling like they are choking or suffocating, thereby increasing their sense of stress. In the past decade obstructive sleep apnea has been found to be linked to a variety of cardiovascular diseases, neurocognitive dysfunction, and behavioral disorders. 2,3Patients with sleep apnea may also have substantial comorbid mental disorders, such as depression, anxiety, bipolar disorder, schizophrenia, post-traumatic stress syndrome, and substance abuse. 4 Panic disorder is an extreme pole of anxiety disorder with features of recurrent panic attacks. There are, however, few studies addressing the relationship between sleep apnea and panic disorder, and most of these studies are small or lack an appropriate control group.5-9 A crossover study enrolling 12 patients with panic disorder who also had obstructive sleep apnea showed that they benefited from continuous positive airway pressure (CPAP) therapy, which decreased the panic attacks and reduced the use of alprazolam, suggesting an interaction of both diseases. 10 We therefore undertook this nationwide population-based study to elucidate the relationship of sleep apnea and subsequent panic disorder. 11 The data used in this study were retrieved from the Longitudinal Health Insurance Database 2000 (LHID2000), comprised of approximately 1,000,000 randomly sampl...

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“…The diagnostic accuracy of SDB in NHIRD, however, has been validated in a single-center cohort previously, and around 83% of the diagnosis was confirmed on overnight polysomnography, with approximately 90% of them having an apnea-hypopnea index >5. 22 Last, we analyzed data on CPAP use only when study subjects were enrolled; whether patients continued to receive CPAP treatment during the follow-up period was uncertain. Consequently, it is unclear whether patients with SDB who received regular CPAP treatment had a lower risk of AF compared to patients with a similar severity of SDB but without long-term CPAP use.…”

Section: Study Limitationsmentioning

confidence: 99%