Risk of Alzheimer's Disease in Obstructive Sleep Apnea Patients With or Without Treatment: Real‐World Evidence
Objective To assess the risk of Alzheimer's disease (AD) in patients with obstructive sleep apnea (OSA) with or without treatment based on real‐world evidence. Study Design Retrospective cohort study. Methods Patients newly diagnosed with OSA during 1997–2012 were identified using the National...
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| Veröffentlicht in: | The Laryngoscope 2020-09, Vol.130 (9), p.2292-2298 |
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| creator | Tsai, Ming‐Shao Li, Hsueh‐Yu Huang, Chung‐Guei Wang, Robert Y.L. Chuang, Li‐Pang Chen, Ning‐Hung Liu, Chi‐Hung Yang, Yao‐Hsu Liu, Chia‐Yen Hsu, Cheng‐Ming Cheng, Wen‐Nuan Lee, Li‐Ang |
| description | Objective
To assess the risk of Alzheimer's disease (AD) in patients with obstructive sleep apnea (OSA) with or without treatment based on real‐world evidence.
Study Design
Retrospective cohort study.
Methods
Patients newly diagnosed with OSA during 1997–2012 were identified using the National Health Insurance Research Database of Taiwan. Patients without OSA were randomly selected and matched in a 1:4 ratio by age, sex, urbanization level, and income. All patients were followed up until death or the end of 2013. The primary outcome was AD occurrence.
Results
This study included 3,978 OSA patients and 15,912 non‐OSA patients. OSA was independently and significantly associated with a higher incidence of AD in an adjusted Cox proportional hazard model (adjusted hazard ratio: 2.12; 95% confidence interval [CI], 1.27–3.56). The average period of AD detection from the time of OSA occurrence was 5.44 years (standard deviation: 2.96). Subgroup analyses revealed that the effect of OSA remained significant in patients aged ≥60 years, male subgroups, patients without CPAP or surgical treatment, and patients without pharmacological therapies. Patients with OSA who received treatment (continuous positive airway pressure or surgery) exhibited a significantly reduced risk of AD compared with those without treatment (incidence rate ratio 0.23, 95% CI, 0.06–0.98).
Conclusion
OSA is independently associated with an increased risk of AD. Treatment for OSA reduces the AD risk in OSA patients. AD irreversibility renders OSA as a potential modifiable target for slowing or preventing the process of AD development.
Level of Evidence
IV Laryngoscope, 130:2292–2298, 2020 |
| doi_str_mv | 10.1002/lary.28558 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2353580234</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2434044341</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3578-b97ab783fc352e13bb68503876dc1b07026938d8407a0d732188116f046dddd13</originalsourceid><addsrcrecordid>eNp9kctq3DAUhkVJaSbTbvIAQZBFSsHpkWTZmuyGNL3AQMo0Jc1KyPYxUSJfItkTpqs-Qp-xT1JNJs0ii2qhgzgfH-L_CdlncMwA-Htn_PqYKynVCzJhUrAknc3kDpnEpUiU5D92yV4INwAsFxJekV3BIZXAYEL6pQ23tKvp3P28RtugPwr0gw1oAlLb0vMiDH4sB7tC-s0h9nTet2joVzNYbIdAL-1wTTv_MLtxoBcezdDE1QldonF_fv2-7Lyr6NnKVtiW-Jq8rI0L-OZxTsn3j2cXp5-TxfmnL6fzRVIKmaukmOWmyJWo45MjE0WRKQlC5VlVsgJy4NlMqEqlkBuocsGZUoxlNaRZFQ8TU_J26-19dzdiGHRjQ4nOmRa7MWgupJAqBpRG9PAZetONvo2_0zwVKaTx2gjfbanSdyF4rHXvbROj1wz0pge96UE_9BDhg0flWDRYPaH_go8A2wL31uH6Pyq9mC-vttK_0zGSVA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2434044341</pqid></control><display><type>article</type><title>Risk of Alzheimer's Disease in Obstructive Sleep Apnea Patients With or Without Treatment: Real‐World Evidence</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Tsai, Ming‐Shao ; Li, Hsueh‐Yu ; Huang, Chung‐Guei ; Wang, Robert Y.L. ; Chuang, Li‐Pang ; Chen, Ning‐Hung ; Liu, Chi‐Hung ; Yang, Yao‐Hsu ; Liu, Chia‐Yen ; Hsu, Cheng‐Ming ; Cheng, Wen‐Nuan ; Lee, Li‐Ang</creator><creatorcontrib>Tsai, Ming‐Shao ; Li, Hsueh‐Yu ; Huang, Chung‐Guei ; Wang, Robert Y.L. ; Chuang, Li‐Pang ; Chen, Ning‐Hung ; Liu, Chi‐Hung ; Yang, Yao‐Hsu ; Liu, Chia‐Yen ; Hsu, Cheng‐Ming ; Cheng, Wen‐Nuan ; Lee, Li‐Ang</creatorcontrib><description>Objective
To assess the risk of Alzheimer's disease (AD) in patients with obstructive sleep apnea (OSA) with or without treatment based on real‐world evidence.
Study Design
Retrospective cohort study.
Methods
Patients newly diagnosed with OSA during 1997–2012 were identified using the National Health Insurance Research Database of Taiwan. Patients without OSA were randomly selected and matched in a 1:4 ratio by age, sex, urbanization level, and income. All patients were followed up until death or the end of 2013. The primary outcome was AD occurrence.
Results
This study included 3,978 OSA patients and 15,912 non‐OSA patients. OSA was independently and significantly associated with a higher incidence of AD in an adjusted Cox proportional hazard model (adjusted hazard ratio: 2.12; 95% confidence interval [CI], 1.27–3.56). The average period of AD detection from the time of OSA occurrence was 5.44 years (standard deviation: 2.96). Subgroup analyses revealed that the effect of OSA remained significant in patients aged ≥60 years, male subgroups, patients without CPAP or surgical treatment, and patients without pharmacological therapies. Patients with OSA who received treatment (continuous positive airway pressure or surgery) exhibited a significantly reduced risk of AD compared with those without treatment (incidence rate ratio 0.23, 95% CI, 0.06–0.98).
Conclusion
OSA is independently associated with an increased risk of AD. Treatment for OSA reduces the AD risk in OSA patients. AD irreversibility renders OSA as a potential modifiable target for slowing or preventing the process of AD development.
Level of Evidence
IV Laryngoscope, 130:2292–2298, 2020</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1002/lary.28558</identifier><identifier>PMID: 32045010</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Adult ; Alzheimer Disease - epidemiology ; Alzheimer Disease - etiology ; Alzheimer's disease ; Continuous positive airway pressure ; Continuous Positive Airway Pressure - statistics & numerical data ; Databases, Factual ; dementia ; Female ; Humans ; Incidence ; Male ; Middle Aged ; obstructive sleep apnea ; Otorhinolaryngologic Surgical Procedures - statistics & numerical data ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Sleep apnea ; Sleep Apnea, Obstructive - psychology ; Sleep Apnea, Obstructive - therapy ; sleep disturbance ; snoring ; Taiwan - epidemiology ; Treatment Outcome</subject><ispartof>The Laryngoscope, 2020-09, Vol.130 (9), p.2292-2298</ispartof><rights>2020 The American Laryngological, Rhinological and Otological Society, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3578-b97ab783fc352e13bb68503876dc1b07026938d8407a0d732188116f046dddd13</citedby><cites>FETCH-LOGICAL-c3578-b97ab783fc352e13bb68503876dc1b07026938d8407a0d732188116f046dddd13</cites><orcidid>0000-0002-0598-5684 ; 0000-0003-3792-3784 ; 0000-0001-8414-595X ; 0000-0002-9314-5940 ; 0000-0002-9016-8098</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flary.28558$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flary.28558$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32045010$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tsai, Ming‐Shao</creatorcontrib><creatorcontrib>Li, Hsueh‐Yu</creatorcontrib><creatorcontrib>Huang, Chung‐Guei</creatorcontrib><creatorcontrib>Wang, Robert Y.L.</creatorcontrib><creatorcontrib>Chuang, Li‐Pang</creatorcontrib><creatorcontrib>Chen, Ning‐Hung</creatorcontrib><creatorcontrib>Liu, Chi‐Hung</creatorcontrib><creatorcontrib>Yang, Yao‐Hsu</creatorcontrib><creatorcontrib>Liu, Chia‐Yen</creatorcontrib><creatorcontrib>Hsu, Cheng‐Ming</creatorcontrib><creatorcontrib>Cheng, Wen‐Nuan</creatorcontrib><creatorcontrib>Lee, Li‐Ang</creatorcontrib><title>Risk of Alzheimer's Disease in Obstructive Sleep Apnea Patients With or Without Treatment: Real‐World Evidence</title><title>The Laryngoscope</title><addtitle>Laryngoscope</addtitle><description>Objective
To assess the risk of Alzheimer's disease (AD) in patients with obstructive sleep apnea (OSA) with or without treatment based on real‐world evidence.
Study Design
Retrospective cohort study.
Methods
Patients newly diagnosed with OSA during 1997–2012 were identified using the National Health Insurance Research Database of Taiwan. Patients without OSA were randomly selected and matched in a 1:4 ratio by age, sex, urbanization level, and income. All patients were followed up until death or the end of 2013. The primary outcome was AD occurrence.
Results
This study included 3,978 OSA patients and 15,912 non‐OSA patients. OSA was independently and significantly associated with a higher incidence of AD in an adjusted Cox proportional hazard model (adjusted hazard ratio: 2.12; 95% confidence interval [CI], 1.27–3.56). The average period of AD detection from the time of OSA occurrence was 5.44 years (standard deviation: 2.96). Subgroup analyses revealed that the effect of OSA remained significant in patients aged ≥60 years, male subgroups, patients without CPAP or surgical treatment, and patients without pharmacological therapies. Patients with OSA who received treatment (continuous positive airway pressure or surgery) exhibited a significantly reduced risk of AD compared with those without treatment (incidence rate ratio 0.23, 95% CI, 0.06–0.98).
Conclusion
OSA is independently associated with an increased risk of AD. Treatment for OSA reduces the AD risk in OSA patients. AD irreversibility renders OSA as a potential modifiable target for slowing or preventing the process of AD development.
Level of Evidence
IV Laryngoscope, 130:2292–2298, 2020</description><subject>Adult</subject><subject>Alzheimer Disease - epidemiology</subject><subject>Alzheimer Disease - etiology</subject><subject>Alzheimer's disease</subject><subject>Continuous positive airway pressure</subject><subject>Continuous Positive Airway Pressure - statistics & numerical data</subject><subject>Databases, Factual</subject><subject>dementia</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>obstructive sleep apnea</subject><subject>Otorhinolaryngologic Surgical Procedures - statistics & numerical data</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sleep apnea</subject><subject>Sleep Apnea, Obstructive - psychology</subject><subject>Sleep Apnea, Obstructive - therapy</subject><subject>sleep disturbance</subject><subject>snoring</subject><subject>Taiwan - epidemiology</subject><subject>Treatment Outcome</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctq3DAUhkVJaSbTbvIAQZBFSsHpkWTZmuyGNL3AQMo0Jc1KyPYxUSJfItkTpqs-Qp-xT1JNJs0ii2qhgzgfH-L_CdlncMwA-Htn_PqYKynVCzJhUrAknc3kDpnEpUiU5D92yV4INwAsFxJekV3BIZXAYEL6pQ23tKvp3P28RtugPwr0gw1oAlLb0vMiDH4sB7tC-s0h9nTet2joVzNYbIdAL-1wTTv_MLtxoBcezdDE1QldonF_fv2-7Lyr6NnKVtiW-Jq8rI0L-OZxTsn3j2cXp5-TxfmnL6fzRVIKmaukmOWmyJWo45MjE0WRKQlC5VlVsgJy4NlMqEqlkBuocsGZUoxlNaRZFQ8TU_J26-19dzdiGHRjQ4nOmRa7MWgupJAqBpRG9PAZetONvo2_0zwVKaTx2gjfbanSdyF4rHXvbROj1wz0pge96UE_9BDhg0flWDRYPaH_go8A2wL31uH6Pyq9mC-vttK_0zGSVA</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Tsai, Ming‐Shao</creator><creator>Li, Hsueh‐Yu</creator><creator>Huang, Chung‐Guei</creator><creator>Wang, Robert Y.L.</creator><creator>Chuang, Li‐Pang</creator><creator>Chen, Ning‐Hung</creator><creator>Liu, Chi‐Hung</creator><creator>Yang, Yao‐Hsu</creator><creator>Liu, Chia‐Yen</creator><creator>Hsu, Cheng‐Ming</creator><creator>Cheng, Wen‐Nuan</creator><creator>Lee, Li‐Ang</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0598-5684</orcidid><orcidid>https://orcid.org/0000-0003-3792-3784</orcidid><orcidid>https://orcid.org/0000-0001-8414-595X</orcidid><orcidid>https://orcid.org/0000-0002-9314-5940</orcidid><orcidid>https://orcid.org/0000-0002-9016-8098</orcidid></search><sort><creationdate>202009</creationdate><title>Risk of Alzheimer's Disease in Obstructive Sleep Apnea Patients With or Without Treatment: Real‐World Evidence</title><author>Tsai, Ming‐Shao ; Li, Hsueh‐Yu ; Huang, Chung‐Guei ; Wang, Robert Y.L. ; Chuang, Li‐Pang ; Chen, Ning‐Hung ; Liu, Chi‐Hung ; Yang, Yao‐Hsu ; Liu, Chia‐Yen ; Hsu, Cheng‐Ming ; Cheng, Wen‐Nuan ; Lee, Li‐Ang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3578-b97ab783fc352e13bb68503876dc1b07026938d8407a0d732188116f046dddd13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Alzheimer Disease - epidemiology</topic><topic>Alzheimer Disease - etiology</topic><topic>Alzheimer's disease</topic><topic>Continuous positive airway pressure</topic><topic>Continuous Positive Airway Pressure - statistics & numerical data</topic><topic>Databases, Factual</topic><topic>dementia</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>obstructive sleep apnea</topic><topic>Otorhinolaryngologic Surgical Procedures - statistics & numerical data</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sleep apnea</topic><topic>Sleep Apnea, Obstructive - psychology</topic><topic>Sleep Apnea, Obstructive - therapy</topic><topic>sleep disturbance</topic><topic>snoring</topic><topic>Taiwan - epidemiology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tsai, Ming‐Shao</creatorcontrib><creatorcontrib>Li, Hsueh‐Yu</creatorcontrib><creatorcontrib>Huang, Chung‐Guei</creatorcontrib><creatorcontrib>Wang, Robert Y.L.</creatorcontrib><creatorcontrib>Chuang, Li‐Pang</creatorcontrib><creatorcontrib>Chen, Ning‐Hung</creatorcontrib><creatorcontrib>Liu, Chi‐Hung</creatorcontrib><creatorcontrib>Yang, Yao‐Hsu</creatorcontrib><creatorcontrib>Liu, Chia‐Yen</creatorcontrib><creatorcontrib>Hsu, Cheng‐Ming</creatorcontrib><creatorcontrib>Cheng, Wen‐Nuan</creatorcontrib><creatorcontrib>Lee, Li‐Ang</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tsai, Ming‐Shao</au><au>Li, Hsueh‐Yu</au><au>Huang, Chung‐Guei</au><au>Wang, Robert Y.L.</au><au>Chuang, Li‐Pang</au><au>Chen, Ning‐Hung</au><au>Liu, Chi‐Hung</au><au>Yang, Yao‐Hsu</au><au>Liu, Chia‐Yen</au><au>Hsu, Cheng‐Ming</au><au>Cheng, Wen‐Nuan</au><au>Lee, Li‐Ang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk of Alzheimer's Disease in Obstructive Sleep Apnea Patients With or Without Treatment: Real‐World Evidence</atitle><jtitle>The Laryngoscope</jtitle><addtitle>Laryngoscope</addtitle><date>2020-09</date><risdate>2020</risdate><volume>130</volume><issue>9</issue><spage>2292</spage><epage>2298</epage><pages>2292-2298</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><abstract>Objective
To assess the risk of Alzheimer's disease (AD) in patients with obstructive sleep apnea (OSA) with or without treatment based on real‐world evidence.
Study Design
Retrospective cohort study.
Methods
Patients newly diagnosed with OSA during 1997–2012 were identified using the National Health Insurance Research Database of Taiwan. Patients without OSA were randomly selected and matched in a 1:4 ratio by age, sex, urbanization level, and income. All patients were followed up until death or the end of 2013. The primary outcome was AD occurrence.
Results
This study included 3,978 OSA patients and 15,912 non‐OSA patients. OSA was independently and significantly associated with a higher incidence of AD in an adjusted Cox proportional hazard model (adjusted hazard ratio: 2.12; 95% confidence interval [CI], 1.27–3.56). The average period of AD detection from the time of OSA occurrence was 5.44 years (standard deviation: 2.96). Subgroup analyses revealed that the effect of OSA remained significant in patients aged ≥60 years, male subgroups, patients without CPAP or surgical treatment, and patients without pharmacological therapies. Patients with OSA who received treatment (continuous positive airway pressure or surgery) exhibited a significantly reduced risk of AD compared with those without treatment (incidence rate ratio 0.23, 95% CI, 0.06–0.98).
Conclusion
OSA is independently associated with an increased risk of AD. Treatment for OSA reduces the AD risk in OSA patients. AD irreversibility renders OSA as a potential modifiable target for slowing or preventing the process of AD development.
Level of Evidence
IV Laryngoscope, 130:2292–2298, 2020</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>32045010</pmid><doi>10.1002/lary.28558</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0598-5684</orcidid><orcidid>https://orcid.org/0000-0003-3792-3784</orcidid><orcidid>https://orcid.org/0000-0001-8414-595X</orcidid><orcidid>https://orcid.org/0000-0002-9314-5940</orcidid><orcidid>https://orcid.org/0000-0002-9016-8098</orcidid></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Adult Alzheimer Disease - epidemiology Alzheimer Disease - etiology Alzheimer's disease Continuous positive airway pressure Continuous Positive Airway Pressure - statistics & numerical data Databases, Factual dementia Female Humans Incidence Male Middle Aged obstructive sleep apnea Otorhinolaryngologic Surgical Procedures - statistics & numerical data Proportional Hazards Models Retrospective Studies Risk Factors Sleep apnea Sleep Apnea, Obstructive - psychology Sleep Apnea, Obstructive - therapy sleep disturbance snoring Taiwan - epidemiology Treatment Outcome |
| title | Risk of Alzheimer's Disease in Obstructive Sleep Apnea Patients With or Without Treatment: Real‐World Evidence |
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