Risk of obstructive sleep apnea in patients with schizophrenia: a nationwide population-based cohort study
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ORIGINAL PAPER
Risk of obstructive sleep apnea in patients with schizophrenia: a nationwide population‑based cohort study Ying‑Ying Wu1 · En‑Ting Chang2,6 · Yu‑Cih Yang3 · Shih‑Fen Chen4 · Chung‑Y Hsu5 · Yu‑Chih Shen1,6 Received: 16 October 2019 / Accepted: 2 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Patients with schizophrenia (SCZ) have a higher prevalence of known risk factors for obstructive sleep apnea (OSA). This study aims to determine if SCZ patients are at increased risk of incident OSA. Methods A total of 5092 newly diagnosed SCZ patients and 5092 non-SCZ controls matched by gender, age, and index year were included between 2000 and 2012 and followed to 2013. Participants newly diagnosed with OSA were defined as incidents. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence intervals (CI) of the OSA incidence rate between the two groups studied. Results SCZ patients were at increased risk of OSA compared to non-SCZ controls after adjusting for gender, age, comorbidities, and duration of antipsychotic use (2.12 versus 1.01 per 1000 person-years, HR: 1.97, 95% CI: 1.36–2.85). Also, this study confirmed the existence of some known risk factors for OSA, including male gender (HR 1.65, 95% CI 1.14–2.37), obesity (HR 2.62, 95% CI 1.19–5.80), hypertension (HR 1.61, 95% CI 1.06–2.47), hyperlipidemia (HR 1.55, 95% CI 1.04–2.38), diabetes (HR 1.53, 95% CI 1.01–2.38), and antipsychotic use (duration 99% of the population of Taiwan. The data bank consists of extensive relevant information on covered individuals, including demographic data, disease diagnoses, medical procedures, and other related information. Disease diagnoses were coded by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). In recent years, efforts to validate diagnosed codes or develop methodological approaches to address unmeasured confounders have significantly increased the reliability of NHIRD studies [18]. Several subsets of data have been created within the NHIRD, and one of them, The Longitudinal Health Insurance Database 2000 (LHID2000), was used for this study. LHID2000 includes all health-care information of 1,000,000 individuals randomly chosen from NHIRD between 1995 and 2013 (roughly 4% of the population of Taiwan). The population was chosen to be representative of the NHIRD population and the country as a whole.
Inclusion criteria Patients newly diagnosed with SCZ (ICD-9-CM code: 295; no SCZ medical records between 1995 and 2000) by boardcertified psychiatrists between 2000 and 2012 in LHID2000 were enrolled in the SCZ cohort. The timing of the first diagnosis of SCZ was defined as the index date. Patients with a history of OSA between 1995 and the index date were eliminated from the SCZ cohort. For each patient in the SCZ cohort, one matched control subject by gender, age, and index year (the year of the index date) was identified from the LHID2000 (non-SCZ or control cohort). Individuals diagnosed with SC
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