The effect of sex and age on the comorbidity burden of OSA: an observational analysis from a large nationwide US health claims database
The effect of sex and age on the comorbidity burden of OSA: an observational analysis from a large nationwide US health claims database
复制标题
DOI：
10.1183/13993003.01618-2015
复制
发表时间：
2016-04-01
影响因子：
24.3
通讯作者：
Gozal, David
中科院分区：
文献类型：
--
作者：
Mokhlesi, Babak;Ham, Sandra A.;Gozal, David
阻塞性睡眠呼吸暂停（OSA）是一种非常普遍的疾病，但研究探索OSA相关的合并症的负担一直受到样本量小，女性代表性不足的限制，我们查询了Truven Health MarketScan Research Databases 2003-2012，这是一个收集的健康保险索赔的工作成年人和退休人员与雇主赞助的健康保险。从OSA诊断的索引日期起至少随访12个月的具有OSA诊断代码的成人与匹配的随机样本进行比较。采用国际疾病分类第九版编码评估合并症。我们的队列包括1704905名OSA患者和1704417名匹配的对照者，建立Logistic回归模型来检验OSA与合并症之间的独立关联。所有合并症在OSA患者中明显更普遍。2型糖尿病和缺血性心脏病在男性中更普遍，但高血压和抑郁症在OSA女性中更普遍。相比之下，充血性心力衰竭、心律失常和中风患病率的性别差异不太明显。合并症的患病率随着年龄的增长而增加，但年龄的影响因具体合并症而异。对于大多数心血管疾病（即心力衰竭、缺血性心脏病、中风和心律失常），OSA和对照组之间的差异在60岁以后更加明显，而抑郁症则表现出相反的趋势。在一个完全校正的模型中，OSA患者所有合并症的几率都显著增加，在一个大的，具有全国代表性的工作和退休人群样本中，OSA与男性和女性的显著合并症密切相关，并出现独特的性别差异。
Obstructive sleep apnoea (OSA) is a highly prevalent condition but studies exploring the burden of OSA-associated comorbidities have been limited by small sample sizes with underrepresentation of women.We queried the Truven Health MarketScan Research Databases 2003-2012, which is a collection of health insurance claims for working adults and retirees with employer-sponsored health insurance. Adults with a diagnostic code for OSA with at least 12 months of follow-up from the index date of OSA diagnosis were compared to a matched random sample. Comorbidities were assessed using International Classification of Diseases, Ninth Edition, codes. A logistic regression model was constructed to test the independent association between OSA and comorbidities.Our cohort included 1 704 905 patients with OSA and 1 704 417 matched controls. All comorbidities were significantly more prevalent in OSA patients. Type 2 diabetes and ischaemic heart disease were more prevalent in men but hypertension and depression were more prevalent in women with OSA. In contrast, the sex differences in the prevalence of congestive heart failure, arrhythmias and stroke were less pronounced. The prevalence of comorbidities increased with age but the effect of age varied based on the specific comorbidity. The divergence between OSA and controls was more pronounced after the sixth decade of life for most cardiovascular diseases (i.e. heart failure, ischaemic heart disease, stroke and arrhythmias), while depression exhibited an opposite trend. In a fully adjusted model, the odds of all comorbidities were significantly increased in OSA patients.In a large, nationally representative sample of working and retired people, OSA is strongly associated with significant comorbidities in both men and women with unique sex differences emerging.