Management and risk reduction of rheumatoid arthritis in individuals with obstructive sleep apnea: A nationwide population-based study in Taiwan

Wei Sheng Chen, Yu-Sheng Chang, Chi-Ching Chang, Deh Ming Chang, Yi Hsuan Chen, Chang Youh Tsai, Jin-Hua Chen

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Study Objectives: To explore associations between obstructive sleep apnea (OSA) and autoimmune diseases and evaluate whether OSA management reduces the incidence of autoimmune diseases. Methods: This was a retrospective cohort study using nationwide database research. The data was from 105,846 adult patients in whom OSA was diagnosed and recorded in the Taiwan National Health Insurance Research Database between 2002 and 2011 were the patients were analyzed retrospectively. Patients with antecedent autoimmune diseases were excluded. A comparison cohort of 423,384 participants without OSA served as age- and sex-matched controls. Multivariable Cox regression analysis was performed on both cohorts to compute risk of autoimmune diseases during follow-up. Time dependent OSA treatment effect was analyzed among patients with OSA. There were no interventions. Results: Among patients with OSA, overall risk for incident autoimmune diseases was significantly higher than that in controls (adjusted hazard ratio [HR] = 1.95, 95% confidence interval [CI] = 1.66-2.27). Risk for individual autoimmune diseases, including rheumatoid arthritis (RA), Sjögren syndrome (SS), and Behçet disease, was significantly higher in patients with OSA than in controls (HRs [95% CI]: RA 1.33 [1.03-1.72, SS 3.45 [2.67-4.45] and Behçet disease 5.33 [2.45-12.66]). Increased risk for systemic lupus erythematosus (HR 1.00 [0.54-1.84]) and systemic sclerosis (HR 1.43 [0.51-3.96]) did not reach statistical significance. Patients with OSA receiving treatment had an overall reduced risk of RA and other autoimmune diseases (time-dependent HRs [95% CI]: 0.22 [0.05-0.94] and 0.51 [0.28-0.92], respectively). Conclusions: Patients with OSA are associated with higher risk for developing RA, SS, and Behçet disease. OSA management is associated with reduced risk of RA.

Original languageEnglish
Pages (from-to)1883-1890
Number of pages8
JournalSleep
Volume39
Issue number10
DOIs
Publication statusPublished - Oct 1 2016

Fingerprint

Obstructive Sleep Apnea
Risk Reduction Behavior
Taiwan
Rheumatoid Arthritis
Autoimmune Diseases
Population
Confidence Intervals
Databases
Safety Management
Systemic Scleroderma
National Health Programs
Research
Systemic Lupus Erythematosus
Cohort Studies
Retrospective Studies
Regression Analysis

Keywords

  • Autoimmune disease
  • Behçet disease
  • Obstructive sleep apnea
  • Rheumatoid arthritis
  • Sjögren syndrome

ASJC Scopus subject areas

  • Clinical Neurology
  • Physiology (medical)

Cite this

Management and risk reduction of rheumatoid arthritis in individuals with obstructive sleep apnea : A nationwide population-based study in Taiwan. / Chen, Wei Sheng; Chang, Yu-Sheng; Chang, Chi-Ching; Chang, Deh Ming; Chen, Yi Hsuan; Tsai, Chang Youh; Chen, Jin-Hua.

In: Sleep, Vol. 39, No. 10, 01.10.2016, p. 1883-1890.

Research output: Contribution to journalArticle

@article{0aa8af903b8d4f43b150263770477ba7,
title = "Management and risk reduction of rheumatoid arthritis in individuals with obstructive sleep apnea: A nationwide population-based study in Taiwan",
abstract = "Study Objectives: To explore associations between obstructive sleep apnea (OSA) and autoimmune diseases and evaluate whether OSA management reduces the incidence of autoimmune diseases. Methods: This was a retrospective cohort study using nationwide database research. The data was from 105,846 adult patients in whom OSA was diagnosed and recorded in the Taiwan National Health Insurance Research Database between 2002 and 2011 were the patients were analyzed retrospectively. Patients with antecedent autoimmune diseases were excluded. A comparison cohort of 423,384 participants without OSA served as age- and sex-matched controls. Multivariable Cox regression analysis was performed on both cohorts to compute risk of autoimmune diseases during follow-up. Time dependent OSA treatment effect was analyzed among patients with OSA. There were no interventions. Results: Among patients with OSA, overall risk for incident autoimmune diseases was significantly higher than that in controls (adjusted hazard ratio [HR] = 1.95, 95{\%} confidence interval [CI] = 1.66-2.27). Risk for individual autoimmune diseases, including rheumatoid arthritis (RA), Sj{\"o}gren syndrome (SS), and Beh{\cc}et disease, was significantly higher in patients with OSA than in controls (HRs [95{\%} CI]: RA 1.33 [1.03-1.72, SS 3.45 [2.67-4.45] and Beh{\cc}et disease 5.33 [2.45-12.66]). Increased risk for systemic lupus erythematosus (HR 1.00 [0.54-1.84]) and systemic sclerosis (HR 1.43 [0.51-3.96]) did not reach statistical significance. Patients with OSA receiving treatment had an overall reduced risk of RA and other autoimmune diseases (time-dependent HRs [95{\%} CI]: 0.22 [0.05-0.94] and 0.51 [0.28-0.92], respectively). Conclusions: Patients with OSA are associated with higher risk for developing RA, SS, and Beh{\cc}et disease. OSA management is associated with reduced risk of RA.",
keywords = "Autoimmune disease, Beh{\cc}et disease, Obstructive sleep apnea, Rheumatoid arthritis, Sj{\"o}gren syndrome",
author = "Chen, {Wei Sheng} and Yu-Sheng Chang and Chi-Ching Chang and Chang, {Deh Ming} and Chen, {Yi Hsuan} and Tsai, {Chang Youh} and Jin-Hua Chen",
year = "2016",
month = "10",
day = "1",
doi = "10.5665/sleep.6174",
language = "English",
volume = "39",
pages = "1883--1890",
journal = "Sleep",
issn = "0161-8105",
publisher = "American Academy of Sleep Medicine",
number = "10",

}

TY - JOUR

T1 - Management and risk reduction of rheumatoid arthritis in individuals with obstructive sleep apnea

T2 - A nationwide population-based study in Taiwan

AU - Chen, Wei Sheng

AU - Chang, Yu-Sheng

AU - Chang, Chi-Ching

AU - Chang, Deh Ming

AU - Chen, Yi Hsuan

AU - Tsai, Chang Youh

AU - Chen, Jin-Hua

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Study Objectives: To explore associations between obstructive sleep apnea (OSA) and autoimmune diseases and evaluate whether OSA management reduces the incidence of autoimmune diseases. Methods: This was a retrospective cohort study using nationwide database research. The data was from 105,846 adult patients in whom OSA was diagnosed and recorded in the Taiwan National Health Insurance Research Database between 2002 and 2011 were the patients were analyzed retrospectively. Patients with antecedent autoimmune diseases were excluded. A comparison cohort of 423,384 participants without OSA served as age- and sex-matched controls. Multivariable Cox regression analysis was performed on both cohorts to compute risk of autoimmune diseases during follow-up. Time dependent OSA treatment effect was analyzed among patients with OSA. There were no interventions. Results: Among patients with OSA, overall risk for incident autoimmune diseases was significantly higher than that in controls (adjusted hazard ratio [HR] = 1.95, 95% confidence interval [CI] = 1.66-2.27). Risk for individual autoimmune diseases, including rheumatoid arthritis (RA), Sjögren syndrome (SS), and Behçet disease, was significantly higher in patients with OSA than in controls (HRs [95% CI]: RA 1.33 [1.03-1.72, SS 3.45 [2.67-4.45] and Behçet disease 5.33 [2.45-12.66]). Increased risk for systemic lupus erythematosus (HR 1.00 [0.54-1.84]) and systemic sclerosis (HR 1.43 [0.51-3.96]) did not reach statistical significance. Patients with OSA receiving treatment had an overall reduced risk of RA and other autoimmune diseases (time-dependent HRs [95% CI]: 0.22 [0.05-0.94] and 0.51 [0.28-0.92], respectively). Conclusions: Patients with OSA are associated with higher risk for developing RA, SS, and Behçet disease. OSA management is associated with reduced risk of RA.

AB - Study Objectives: To explore associations between obstructive sleep apnea (OSA) and autoimmune diseases and evaluate whether OSA management reduces the incidence of autoimmune diseases. Methods: This was a retrospective cohort study using nationwide database research. The data was from 105,846 adult patients in whom OSA was diagnosed and recorded in the Taiwan National Health Insurance Research Database between 2002 and 2011 were the patients were analyzed retrospectively. Patients with antecedent autoimmune diseases were excluded. A comparison cohort of 423,384 participants without OSA served as age- and sex-matched controls. Multivariable Cox regression analysis was performed on both cohorts to compute risk of autoimmune diseases during follow-up. Time dependent OSA treatment effect was analyzed among patients with OSA. There were no interventions. Results: Among patients with OSA, overall risk for incident autoimmune diseases was significantly higher than that in controls (adjusted hazard ratio [HR] = 1.95, 95% confidence interval [CI] = 1.66-2.27). Risk for individual autoimmune diseases, including rheumatoid arthritis (RA), Sjögren syndrome (SS), and Behçet disease, was significantly higher in patients with OSA than in controls (HRs [95% CI]: RA 1.33 [1.03-1.72, SS 3.45 [2.67-4.45] and Behçet disease 5.33 [2.45-12.66]). Increased risk for systemic lupus erythematosus (HR 1.00 [0.54-1.84]) and systemic sclerosis (HR 1.43 [0.51-3.96]) did not reach statistical significance. Patients with OSA receiving treatment had an overall reduced risk of RA and other autoimmune diseases (time-dependent HRs [95% CI]: 0.22 [0.05-0.94] and 0.51 [0.28-0.92], respectively). Conclusions: Patients with OSA are associated with higher risk for developing RA, SS, and Behçet disease. OSA management is associated with reduced risk of RA.

KW - Autoimmune disease

KW - Behçet disease

KW - Obstructive sleep apnea

KW - Rheumatoid arthritis

KW - Sjögren syndrome

UR - http://www.scopus.com/inward/record.url?scp=84992365101&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992365101&partnerID=8YFLogxK

U2 - 10.5665/sleep.6174

DO - 10.5665/sleep.6174

M3 - Article

C2 - 27397567

AN - SCOPUS:84992365101

VL - 39

SP - 1883

EP - 1890

JO - Sleep

JF - Sleep

SN - 0161-8105

IS - 10

ER -