- 期刊
Association between Insomnia and Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study in Taiwan
失眠與罹患慢性阻塞性肺疾病之關聯性：台灣健保資料庫分析
摘要
前言：失眠可能與許多疾病的發生有關。目前，失眠和慢性阻塞性肺病確切的關聯與病因尚未明瞭。本研究的目的在於探討失眠和慢性阻塞性肺病的關聯性。方法：這是一篇利用台灣國家衛生研究院之健保資料庫進行的回溯式世代研究。從2002年1月1日至2007 年12月31日內把符合收案條件的病患納入研究。收案條件包括病人必須符合年齡≥ 50歲，且符合單次住院診斷中包含失眠之診斷碼或在門診追蹤之個案在一年中有三次或以上失眠的診斷碼。所有的病人從符合條件收案後往後追蹤4年以調查是否有慢性阻塞性肺病的發生。結果：經過篩選之後共收案13390位失眠的病患以及26759位無失眠的病患。在為期四年的追蹤之後，在失眠的病患族群中共有2056 位被診斷慢性阻塞性肺病（47482.2人- 年，發生率：43.30）；而非失眠族群的對照組中則有2230 位病人被診斷慢性阻塞性肺病（100924.69人- 年，發生率：22.10），統計學上有顯著差異。校正病人的年齡，性別，共病，居住區域和社經條件等因素之後所做的迴歸分析中發現失眠的病人有更高的風險會得到慢性阻塞性肺病（校正風險比：1.83；信賴區間：1.71-1.95）。而年齡≥ 65歲的失眠病人有更高的機會得到慢性阻塞性肺病（校正風險比：1.55；信賴區間：1.46-1.65）。此外，若同時合併有高血壓（校正風險比：1.25；信賴區間：1.16-1.33），糖尿病（校正風險比：1.10；信賴區間：1.01-1.20）以及心房顫動（校正風險比：1.71；信賴區間：1.29-2.26）的病人也有較高的風險得到慢性阻塞性肺病。結論：失眠與慢性阻塞性肺病的發生可能有相關。惟失眠與慢性阻塞性肺疾病之相關性和機轉仍有待進一步研究。
並列摘要
Introduction: Insomnia often occurs concomitantly with many diseases and may be a risk factor for or associated with various diseases. However, the relationship between insomnia and chronic obstructive pulmonary disease (COPD) remains unclear. The aim of this study was to investigate the association between insomnia and COPD. Methods: This was a retrospective cohort study based on data from January 1, 2002 to December 31, 2007 released by the Taiwan National Health Research Institute. The inclusion criteria were age ≥ 50 years and at least 1 hospitalization with a diagnostic code of insomnia or at least 3 outpatient visits with a diagnostic code of insomnia within the same year. All patients were tracked for 4 years from the index date in order to identify those who developed COPD. Results: During the 4-year study period, 13,390 patients with insomnia and 26759 without insomnia were enrolled for analysis. A total of 2056 patients with insomnia (47482.2 person-years, incidence rate (IR): 43.3) and 2230 patients without insomnia (100924.7 person-years, IR: 22.1) were diagnosed with COPD. Regression analysis adjusted for age, gender and comorbidity revealed that the patients with insomnia had a greater risk of developing COPD (adjusted hazard ratio (aHR)=1.83; confidence interval (CI): 1.71-1.95). Those aged ≥ 65 years (aHR=1.55, CI: 1.46-1.65) also had a greater risk of COPD. The presence of hypertension (aHR=1.25; CI: 1.16-1.33), diabetes (aHR=1.10; CI: 1.01-1.20), and atrial fibrillation (aHR=1.71; CI: 1.29-2.26) also increased the risk of developing COPD. Conclusion: Insomnia may be associated with the development of COPD. Further studies are needed to investigate the mechanism linking insomnia and COPD and their association.