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Sleep disorders associated with risk of rheumatoid arthritis

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Background

Immune disorders impair sleep quality and sleep disorders (SDs) may derange immune function.

Purpose

The study evaluated the incidence and risk of rheumatoid arthritis (RA) in patients with SDs using a nationwide cohort.

Methods

We recognized the patients with SDs from 1998 to 2002 by using the Taiwan National Health Insurance Research Database. One control patient for each SD patient was randomly selected and matched based on the proportion of age, sex, and index year. We calculated the person years of follow-up for each participant from the index date to RA diagnosis, censoring, or until December 31, 2011. The risk of RA was estimated by using Cox models incorporating demographics and comorbidities.

Results

We enrolled 65,754 patients with SDs and 65,753 controls and followed for 637,906 and 662,514 person-years, respectively. The patients with SDs exhibited a 1.49-fold greater risk of RA development compared with the comparison cohort when we adjusted for covariates. The patients with sleep apnea (SA) showed the greatest incidence density rate of RA, followed by those with non-apnea SDs and the non-SD cohort (4.11, 3.29, and 2.15 per 10,000 person-years, respectively). The SA cohort had a 2.56-fold adjusted hazard ratio (aHR) of RA (95% confidence interval [CI] = 1.11–5.91) and the non-apnea SD cohort had a 1.47-fold aHR of RA (95% CI = 1.18–1.84) compared with the non-SD cohort. Women with SDs presented a considerable risk of developing RA.

Conclusions

This nationwide cohort study indicates that SDs are associated with the risk of RA development.

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Acknowledgments

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW104-TDU-B-212-113002). The funders did not involve in study design, data collection and analysis, decision to publish, and preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, No. 199, Section 1, San-Min Road, Taichung City, 40343, Taiwan

    Wei-Sheng Chung

  2. Department of Health Services Administration, China Medical University, Taichung, Taiwan

    Wei-Sheng Chung

  3. Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan

    Wei-Sheng Chung

  4. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Cheng-Li Lin

  5. College of Medicine, China Medical University, Taichung, Taiwan

    Cheng-Li Lin

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  1. Wei-Sheng Chung
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Contributions

All authors have substantially contributed to the research and manuscript: preparation. Conception of design: Wei-Sheng Chung, data collection: all authors, data analysis and interpretation: all authors, manuscript writing: all authors, and final approval of manuscript: Wei-Sheng Chung and Cheng-Li Lin.

Corresponding author

Correspondence to Wei-Sheng Chung.

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Conflict of interest

The authors declare that they have no competing interest.

Additional information

Key message

1. Sleep disorders (SDs) carried a 1.49-fold risk of RA development.

2. The adjusted hazard ratio of RA was 2.56 higher in the sleep apnea cohort and 1.47 higher in the non-apnea SD cohort than that in the comparison cohort.

3. Women with SDs exhibited a considerably higher risk of RA.

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Chung, WS., Lin, CL. Sleep disorders associated with risk of rheumatoid arthritis. Sleep Breath 22, 1083–1091 (2018). https://doi.org/10.1007/s11325-018-1639-1

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  • DOI: https://doi.org/10.1007/s11325-018-1639-1

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