Risk of gallstones in patients with obstructive sleep apnea: a nationwide observational cohort study
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To assess the association between obstructive sleep apnea (OSA) and gallstones.
We identified 3827 patients aged ≥ 20 years with OSA between 2000 and 2010 from the Longitudinal Health Insurance Research Database 2000 (LHID2000) as the study cohort. The beneficiaries without OSA were randomly selected and propensity-matched with the study cohort in a 1:1 ratio according to age; sex; occupation; urbanization; comorbidities of hypothyroidism, hyperlipidemia, diabetes, liver cirrhosis, alcohol-related illness, hypertension, chronic obstructive pulmonary disease (COPD), obesity, inflammatory bowel disease, stroke, coronary artery disease (CAD), hepatitis B virus, and hepatitis C virus; and the index year. All patients were followed until the end of 2011 or withdrawal from the National Health Insurance program to determine the incidence of gallstones.
The prevalence of OSA was higher in men (67.3%) and in patients younger than 49 years (57.0%; mean age 47.8 ± 15.1 years). The cumulative incidence of gallstones was higher in the OSA cohort than in the non-OSA cohort (log-rank test, P < 0.001). Compared with patients without OSA, those with OSA had an increased risk of gallstones (adjusted hazard ratio = 1.53, 95% confidence interval = 1.16–2.03) after adjustment for age, sex, hyperlipidemia, diabetes, hypertension, COPD, stroke, and CAD.
The study shows a strong association between OSA and gallstones. Moreover, our findings suggest the requirement for survey and health education for gallstones in OSA and further studies to verify whether the treatment of OSA can reduce the risk of gallstones.
KeywordsObstructive sleep apnea Gallstones Comorbidities
obstructive sleep apnea
Longitudinal Health Insurance Research Database 2000
chronic obstructive pulmonary disease
body mass index
inflammatory bowel disease
coronary artery disease
hepatitis B virus
hepatitis C virus infection
adjusted hazard ratio
National Health Insurance
International Classification of Diseases, Ninth Edition, Clinical Modification
non-alcoholic fatty liver disease
Conceptualization: CHC, CHK
Methodology: CHC, CLL, CHK
Software: CLL, CHK
Validation: CHC, CLL, CHK
Formal analysis: CHC, CLL, CHK
Investigation: CHC, CHK
Resources: CHC, CHK
Data curation: CHC, CLL, CHK
Writing (original draft preparation): all authors
Writing (review and editing): all authors
Visualization: all authors
Supervision: CHC, CHK
Project administration: CYH, CHK
Funding acquisition: CYH, CHK
This work was supported by grants from the Ministry of Health and Welfare, Taiwan (MOHW107-TDUB-212-123004), China Medical University Hospital (DMR-107-192), Academia Sinica Stroke Biosignature Project (BM10701010021), MOST Clinical Trial Consortium for Stroke (MOST 106-2321-B-039-005), Tseng-Lien Lin Foundation, Taichung, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The NHIRD encrypts patient personal information to protect privacy and provides researchers with anonymous identification numbers associated with relevant claim information, including sex, date of birth, medical services received, and prescriptions. Therefore, patient consent is not required to access the NHIRD. This study was approved to fulfill the condition for exemption by the Institutional Review Board (IRB) of China Medical University (CMUH104-REC2-115-CR2). The IRB also specifically waived the consent requirement.
For this type of study, formal consent is not required.
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