0914 Association Between Obstructive Sleep Apnea, Nightmare Disorder and Incident Herpes Zoster

Abstract Introduction Obstructive sleep apnea (OSA) and herpes zoster (HZ) represent treatable and preventable conditions respectively. Nightmares are strongly associated with OSA and may represent troubled sleep. All of these conditions are of growing concern in the Veterans Administration. Inadequate sleep may result in a weakened immune system, which is a potential factor in the reactivation of Varicella-Zoster virus. Methods We looked at the relationship between OSA, nightmare disorder (NMD), and incident HZ among veterans visiting the James A. Haley Veteran’s Hospital. Twenty-two thousand veterans were drawn by a randomly selected date from each quarter year from 2007–2011 from CPRS/VISTA. In order to increase numbers of rarer exposures, the cohort was supplemented by all patients with a nightmare disorder between 2007–2011. After removing duplicates, the total sample size was 22,891. All outpatient diagnoses and procedures between 2006–2015 were then drawn for this cohort. Patients without HZ were frequency matched as closely as possible to patients with HZ by selecting proximate visits. HZ was considered incident if it first occurred at least 30 days after the exposure diagnoses. Patients whose OSA or NMD did not occur at least 30 days before HZ diagnosis date or matched date for controls were excluded from that analysis. Logistic regression was used to calculate odds ratios (OR). Results Of 3536 patients with OSA, 238 (6.73%) developed HZ; out of the 17037 patients without OSA, 611 (3.59%) developed HZ (OR =1.94, 95%CI =1.66, 2.26). The association remained significant (OR= 1.64, 95%CI =1.37,1.98) after adjusting for age, sex, BMI, Charlson comorbidity index, race, Hispanic ethnicity, marital status, and year. The adjusted association between NMD and HZ was not statistically significant, and was in the unexpected direction (adjusted OR=0.81, 95%CI = 0.52, 1.26). However, just 22 patients had both NMD and HZ. Conclusion OSA is associated later development of HZ. This supports a premise that OSA lowers immune status. Support (If Any) This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.