Increased Risk of Sleep Apnea in Taiwanese Patients with Chronic Obstructive Pulmonary Disease

台灣肺阻塞的病人有較高睡眠呼吸中止症的風險

郭家佑(Chia-Yu Kuo) ； 蔡明儒(Ming-Ju Tsai) ； 李瑞英(Jui-Ying Lee) ； 許超群(Chau-Chyun Sheu) ； 洪仁宇(Jen-Yu Hung) ； 鍾飲文(Inn-Wen Chong)

《胸腔醫學》 34卷5期 (2019/10) Pp. 178-189

摘要

Objective: The potential association between chronic obstructive pulmonary disease (COPD) and sleep apnea has been previously studied; however, the study results are contradictory. Therefore, we designed a nationwide population-based cohort study to determine the association between COPD and sleep apnea in Taiwan. Methods: Using the Taiwan National Health Insurance Research Database, adult patients with a diagnosis of COPD were enrolled; those with a sleep apnea diagnosis prior to their COPD onset were excluded. The date of each patient’s first COPD diagnosis was defined as the index date. Each COPD patient was matched with 5 randomly selected control subjects without a COPD diagnosis. The control subjects were assigned the same index dates as their corresponding COPD patient, and we ensured that they had no sleep apnea diagnosis prior to their index date. Results: A total of 35,095 COPD patients were matched with 175,475 control subjects. The incidence rate of sleep apnea was significantly higher among the COPD patients than among the control subjects (0.5 vs. 1.0 per 1,000 patient-years; p＜0.0001). Multivariable Cox regression analysis revealed COPD to be a significant risk factor for sleep apnea (p＜0.0001). Factors associated with incident sleep apnea among COPD patients in this study included male, resident of northern Taiwan, higher income, heart disease, connective tissue disease and cancer. Conclusion: COPD patients had a significantly higher risk of developing sleep apnea than non-COPD patients. When caring for patients with COPD in any context, clinicians need to pay special attention to the risk of incident sleep apnea, especially among male patients, and those with heart disease, connective tissue disease and cancer.

關鍵字

sleep apnea ； sleep disordered breathing ； chronic obstructive pulmonary disease

並列摘要

目的：肺阻塞（COPD）和睡眠呼吸中止症（SA）兩者之間的關係一直有所爭議。因此，我們進行了一個以全國性的人口為基礎的研究來探討COPD與SA間的關聯性。方法：從台灣全民健康保險研究資料庫中，我們收錄了成人COPD的病人，並排除了在診斷COPD前即確診SA的病人。以病人第一次診斷COPD的日期為指標日期。每個COPD患者與5個隨機選擇之無COPD診斷的對照者配對。對照組在指標日期前確定沒有SA的診斷。結果：本研究共收錄35,095位COPD患者與175,475位對照者進行分析。SA在COPD的病人比起對照組有較高的發生率。以多變項Cox迴歸分析校正後，COPD仍然是發生SA的獨立危險因子。在COPD的病人當中，男性、居住於北台灣、較高收入、合併心血管疾病、結締組織疾病及癌症與較高的SA發生率有關。結論：COPD病人有明顯較高的風險罹患SA。因此，臨床醫師針對COPD的病人需花費更多的注意力在SA的發生，尤其是針對男性、居住於北台灣、較高收入、合併心血管疾病、結締組織疾病及癌症的病人。

並列關鍵字

睡眠呼吸中止 ； 睡眠呼吸障礙 ； 肺阻塞