Sleep and Breathing

, Volume 23, Issue 1, pp 355–362 | Cite as

Risk of gallstones in patients with obstructive sleep apnea: a nationwide observational cohort study

  • Chien-Hua Chen
  • Cheng-Li Lin
  • Chung-Y. Hsu
  • Chia-Hung KaoEmail author
Epidemiology • Original Article



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.


Obstructive 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


confidence interval


adjusted hazard ratio


National Health Insurance


International Classification of Diseases, Ninth Edition, Clinical Modification


apnea–hypopnea index


non-alcoholic fatty liver disease


Author contributions

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

Funding information

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.

Ethical approval

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.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Chien-Hua Chen
    • 1
    • 2
    • 3
    • 4
  • Cheng-Li Lin
    • 5
    • 6
  • Chung-Y. Hsu
    • 7
  • Chia-Hung Kao
    • 7
    • 8
    • 9
    Email author
  1. 1.Digestive Disease CenterShow-Chwan Memorial HospitalChanghuaTaiwan
  2. 2.Digestive Disease CenterChangbing Show-Chwan Memorial HospitalLukangTaiwan
  3. 3.Department of Food Science and TechnologyHungkuang UniversityTaichungTaiwan
  4. 4.Chung Chou University of Science and TechnologyYuanlinTaiwan
  5. 5.Management Office for Health DataChina Medical University HospitalTaichungTaiwan
  6. 6.College of MedicineChina Medical UniversityTaichungTaiwan
  7. 7.Graduate Institute of Biomedical Sciences, School of Medicine, College of MedicineChina Medical UniversityTaichungTaiwan
  8. 8.Department of Nuclear Medicine and PET CenterChina Medical University HospitalTaichungTaiwan
  9. 9.Department of Bioinformatics and Medical EngineeringAsia UniversityTaichungTaiwan

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