Deep Neck Infection Risk in Patients with Sleep Apnea: Real-World Evidence
Abstract
:1. Introduction
2. Methods
2.1. Data Origin
2.2. Study Cohort
2.3. Comparison Cohort
2.4. Cohort Matching
2.5. DNI Incidence (Primary Outcome)
2.6. Treatment Modalities for Sleep Apnea
2.7. Comorbidities
2.8. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CI | confidence interval |
DM | diabetes mellitus |
DNI | deep neck infection |
ESRD | end-stage renal disease |
HR | hazard ratio |
ICD-9-CM | International Classification of Diseases, Ninth Revision, Clinical Modification |
LC | liver cirrhosis |
LHID2005 | Longitudinal Health Insurance Database 2005 |
NHI | National Health Insurance |
NHIRD | National Health Insurance Research Database |
NTD | New Taiwan Dollar |
References
- Chang, G.H.; Ding, M.C.; Chen, Y.C.; Yang, Y.H.; Liu, C.Y.; Chang, P.J.; Lee, C.P.; Lin, M.H.; Hsu, C.M.; Wu, C.Y. Real-world evidence for increased deep neck infection risk in patients with rheumatoid arthritis. Laryngoscope 2019, 130, 1402–1407. [Google Scholar] [CrossRef] [PubMed]
- Chang, G.H.; Su, Y.C.; Lin, K.M.; Liu, C.Y.; Yang, Y.H.; Chang, P.J.; Lin, M.H.; Lee, C.P.; Hsu, C.M.; Tsai, Y.T. Deep neck infection in Systemic Lupus erythematosus patients: Real-World evidence. Sci. Rep. 2020, 10, 4133. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tsai, M.S.; Chang, G.H.; Chen, W.M.; Liu, C.Y.; Lin, M.H.; Chang, P.J.; Huang, T.Y.; Tsai, Y.T.; Wu, C.Y.; Hsu, C.M.; et al. The Association between Decompensated Liver Cirrhosis and Deep Neck Infection: Real-World Evidence. Int. J. Environ. Res. Public Health 2019, 16, 3863. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Huang, T.T.; Liu, T.C.; Chen, P.R.; Tseng, F.Y.; Yeh, T.H.; Chen, Y.S. Deep neck infection: Analysis of 185 cases. Head Neck J. Sci. Spec. Head Neck 2004, 26, 854–860. [Google Scholar] [CrossRef]
- Sakarya, E.U.; Kulduk, E.; Gundogan, O.; Soy, F.K.; Dundar, R.; Kilavuz, A.E.; Ozbay, C.; Eren, E.; Imre, A. Clinical features of deep neck infection: Analysis of 77 patients. Kulak Burun Bogaz Ihtis. Derg. 2015, 25, 102–108. [Google Scholar] [CrossRef] [Green Version]
- Sowerby, L.J.; Rotenberg, B.; Brine, M.; George, C.F.; Parnes, L.S. Sleep apnea, daytime somnolence, and idiopathic dizziness—A novel association. Laryngoscope 2010, 120, 1274–1278. [Google Scholar] [CrossRef]
- Sorajja, D.; Gami, A.S.; Somers, V.K.; Behrenbeck, T.R.; Garcia-Touchard, A.; Lopez-Jimenez, F. Independent association between obstructive sleep apnea and subclinical coronary artery disease. CHEST J. 2008, 133, 927–933. [Google Scholar] [CrossRef] [Green Version]
- Mehra, R.; Stone, K.L.; Varosy, P.D.; Hoffman, A.R.; Marcus, G.M.; Blackwell, T.; Ibrahim, O.A.; Salem, R.; Redline, S. Nocturnal arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: Outcomes of sleep disorders in older men (MrOS sleep) study. Arch. Intern. Med. 2009, 169, 1147–1155. [Google Scholar] [CrossRef] [Green Version]
- Wang, H.; Parker, J.D.; Newton, G.E.; Floras, J.S.; Mak, S.; Chiu, K.L.; Ruttanaumpawan, P.; Tomlinson, G.; Bradley, T.D. Influence of obstructive sleep apnea on mortality in patients with heart failure. J. Am. Coll. Cardiol. 2007, 49, 1625–1631. [Google Scholar] [CrossRef] [Green Version]
- Yaggi, H.K.; Concato, J.; Kernan, W.N.; Lichtman, J.H.; Brass, L.M.; Mohsenin, V. Obstructive sleep apnea as a risk factor for stroke and death. N. Engl. J. Med. 2005, 353, 2034–2041. [Google Scholar] [CrossRef] [Green Version]
- Valham, F.; Mooe, T.; Rabben, T.; Stenlund, H.; Wiklund, U.; Franklin, K.A. Increased risk of stroke in patients with coronary artery disease and sleep apnea: A 10-year follow-up. Circulation 2008, 118, 955–960. [Google Scholar] [CrossRef] [Green Version]
- Calvin, A.D.; Somers, V.K. Obstructive sleep apnea and risk of stroke: Time for a trial. Nat. Rev. Cardiol. 2009, 6, 90–91. [Google Scholar] [CrossRef]
- Arnaud, C.; Dematteis, M.; Pepin, J.L.; Baguet, J.P.; Lévy, P. Obstructive sleep apnea, immuno-inflammation, and atherosclerosis. Semin. Immunopathol. 2009, 31, 113–125. [Google Scholar] [CrossRef] [Green Version]
- Zhang, Z.; Wang, C. Immune status of children with obstructive sleep apnea/hypopnea syndrome. Pak. J. Med. Sci. 2017, 33, 195–199. [Google Scholar] [CrossRef]
- Latorre, C.; Escobar, F.; Velosa, J.; Rubiano, D.; Hidalgo-Martinez, P.; Otero, L. Association between obstructive sleep apnea and comorbidities with periodontal disease in adults. J. Indian Soc. Periodontol. 2018, 22, 215–220. [Google Scholar] [CrossRef]
- Kheirandish-Gozal, L.; Gozal, D. Obstructive Sleep Apnea and Inflammation: Proof of Concept Based on Two Illustrative Cytokines. Int. J. Mol. Sci. 2019, 20, 459. [Google Scholar] [CrossRef] [Green Version]
- Vicente, E.; Marin, J.M.; Carrizo, S.J.; Osuna, C.S.; González, R.; Marin-Oto, M.; Forner, M.; Vicente, P.; Cubero, P.; Gil, A.V.; et al. Upper airway and systemic inflammation in obstructive sleep apnoea. Eur. Respir. J. 2016, 48, 1108–1117. [Google Scholar] [CrossRef] [Green Version]
- NHRI. Sampling Method and Representativeness of Longitudinal Health Insurance Database (LHID). Available online: http://nhird.nhri.org.tw/en/Data_Subsets.html (accessed on 1 October 2017).
- Cheng, C.L.; Chien, H.C.; Lee, C.H.; Lin, S.J.; Yang, Y.H. Validity of in-hospital mortality data among patients with acute myocardial infarction or stroke in National Health Insurance Research Database in Taiwan. Int. J. Cardiol. 2015, 201, 96–101. [Google Scholar] [CrossRef]
- Hsieh, C.Y.; Chen, C.H.; Li, C.Y.; Lai, M.L. Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims database. J. Formos. Med. Assoc. 2015, 114, 254–259. [Google Scholar] [CrossRef]
- Wu, C.S.; Lai, M.S.; Gau, S.S.; Wang, S.C.; Tsai, H.J. Concordance between patient self-reports and claims data on clinical diagnoses, medication use, and health system utilization in Taiwan. PLoS ONE 2014, 9, e112257. [Google Scholar] [CrossRef] [Green Version]
- Yang, C.C.; Chen, P.C.; Hsu, C.W.; Chang, S.L.; Lee, C.C. Validity of the age-adjusted charlson comorbidity index on clinical outcomes for patients with nasopharyngeal cancer post radiation treatment: A 5-year nationwide cohort study. PLoS ONE 2015, 10, e0117323. [Google Scholar] [CrossRef] [PubMed]
- Tsai, M.S.; Yang, Y.H.; Liu, C.Y.; Lin, M.H.; Chang, G.H.; Tsai, Y.T.; Li, H.Y.; Tsai, Y.H.; Hsu, C.M. Unilateral Vocal Fold Paralysis and Risk of Pneumonia: A Nationwide Population-Based Cohort Study. Otolaryngol. Head Neck Surg. Off. J. Am. Acad. 2018, 158, 896–903. [Google Scholar] [CrossRef] [PubMed]
- Tsai, M.S.; Li, H.Y.; Huang, C.G.; Wang, R.Y.; Chuang, L.P.; Chen, N.H.; Liu, C.H.; Yang, Y.H.; Liu, C.Y.; Hsu, C.M. Risk of alzheimer’s disease in obstructive sleep apnea patients with or without treatment: Real-world evidence. Laryngoscope 2020, 130, 2292–2298. [Google Scholar] [CrossRef] [PubMed]
- Tsai, M.S.; Lee, L.A.; Tsai, Y.T.; Yang, Y.H.; Liu, C.Y.; Lin, M.H.; Hsu, C.M.; Chen, C.K.; Li, H.Y. Sleep apnea and risk of vertigo: A nationwide population-based cohort study. Laryngoscope 2018, 128, 763–768. [Google Scholar] [CrossRef] [PubMed]
- Chung, W.S.; Lin, C.L.; Peng, C.L.; Chen, Y.F.; Lu, C.C.; Sung, F.C.; Kao, C.H. Rheumatoid arthritis and risk of acute myocardial infarction—A nationwide retrospective cohort study. Int. J. Cardiol. 2013, 168, 4750–4754. [Google Scholar] [CrossRef]
- Camacho, M.; Li, D.; Kawai, M.; Zaghi, S.; Teixeira, J.; Senchak, A.J.; Brietzke, S.E.; Frasier, S.; Certal, V. Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2016, 126, 2176–2186. [Google Scholar] [CrossRef]
- Todd, C.A.; Bareiss, A.K.; McCoul, E.D.; Rodriguez, K.H. Adenotonsillectomy for obstructive sleep apnea and quality of life: Systematic review and meta-analysis. Otolaryngol. Head Neck Surg. 2017, 157, 767–773. [Google Scholar] [CrossRef] [PubMed]
- Suclla-Velásquez, J.A.; Smedts, C. Obesity: A Risk Factor for Infection after Surgery. In Weight Management; IntechOpen: London, UK, 2020. [Google Scholar]
- Marioni, G.; Rinaldi, R.; Staffieri, C.; Marchese-Ragona, R.; Saia, G.; Stramare, R.; Bertolin, A.; Dal Borgo, R.; Ragno, F.; Staffieri, A. Deep neck infection with dental origin: Analysis of 85 consecutive cases (2000–2006). Acta Oto-Laryngol. 2008, 128, 201–206. [Google Scholar] [CrossRef]
- Tremblay, C.; Beaudry, P.; Bissonnette, C.; Gauthier, C.A.; Girard, S.; Milot, M.P.; Durand, R.; Huynh, N. Periodontitis and Obstructive Sleep Apnea: A Literature Review. J. Dent. Sleep Med. 2018, 4, 103–110. [Google Scholar]
- Chiner, E.; Llombart, M.; Valls, J.; Pastor, E.; Sancho-Chust, J.N.; Andreu, A.L.; Sánchez-de-la-Torre, M.; Barbé, F. Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia. PLoS ONE 2016, 11, e0152749. [Google Scholar] [CrossRef] [Green Version]
- Mok, E.M.; Greenough, G.; Pollack, C.C. Untreated obstructive sleep apnea is associated with increased hospitalization from influenza infection. J. Clin. Sleep Med. JCSM Off. Publ. Am. Acad. Sleep Med. 2020, 16, 2003–2007. [Google Scholar] [CrossRef]
Variables | Study Cohorts | Comparison Cohorts | p-Value | ||
---|---|---|---|---|---|
n = 6114 | n = 24,456 | ||||
n | % | n | % | ||
Gender | 1.000 | ||||
Male | 4234 | 69.3 | 16,936 | 69.3 | |
Female | 1880 | 30.8 | 7520 | 30.8 | |
Age (years) | 1.000 | ||||
<50 | 3477 | 56.9 | 13,908 | 56.9 | |
≥51 | 2637 | 43.1 | 10,548 | 43.1 | |
Urbanized level | 1.000 | ||||
1 (City) | 2046 | 33.5 | 8184 | 33.5 | |
2 | 2968 | 48.5 | 11,872 | 48.5 | |
3 | 795 | 13.0 | 3180 | 13.0 | |
4 (Village) | 305 | 5.0 | 1220 | 5.0 | |
Income level (NTD, per month) | 1.000 | ||||
0 | 1582 | 25.9 | 6328 | 25.9 | |
1–15,840 | 954 | 15.6 | 3816 | 15.6 | |
15,841–25,000 | 1441 | 23.6 | 5764 | 23.6 | |
≥25,001 | 2137 | 35.0 | 8548 | 35.0 | |
Covariates | |||||
DM | 1385 | 22.7 | 3681 | 15.1 | <0.001 |
ESRD | 335 | 5.5 | 833 | 3.4 | <0.001 |
Liver cirrhosis | 144 | 2.4 | 486 | 2.0 | 0.07 |
Autoimmune disease | 296 | 4.8 | 629 | 2.6 | <0.001 |
Obesity | 587 | 9.6 | 484 | 2.0 | <0.001 |
Tonsillectomy or adenotonsillectomy | 268 | 4.4 | 24 | 0.1 | <0.001 |
Treatment for sleep apnea | |||||
Treatment | 2483 | 40.6 | - | - | |
Non-treatment | 3631 | 59.4 | - | - | |
DNI incidence | 72 | 1.2 | 167 | 0.7 | <0.001 |
Variables | Adjusted | 95% CI | p-Value | |
---|---|---|---|---|
HR | ||||
Main model * | 1.74 | 1.32 | 2.29 | <0.001 |
Full model # | 1.71 | 1.28 | 2.28 | <0.001 |
Additional covariates † | ||||
Main model + DM | 1.70 | 1.29 | 2.25 | <0.001 |
Main model + ESRD | 1.75 | 1.32 | 2.30 | <0.001 |
Main model + liver cirrhosis | 1.73 | 1.31 | 2.28 | <0.001 |
Main model + autoimmune disease | 1.72 | 1.30 | 2.27 | <0.001 |
Main model + obesity | 1.78 | 1.35 | 2.36 | <0.001 |
Main model + tonsillectomy or adenotonsillectomy | 1.71 | 1.29 | 2.27 | <0.001 |
Subgroup effects | ||||
Gender | ||||
Male | 1.85 | 1.33 | 2.57 | <0.001 |
Female | 1.52 | 0.92 | 2.51 | 0.102 |
Age (years) | ||||
<50 | 2.06 | 1.42 | 2.99 | <0.001 |
≥50 | 1.42 | 0.94 | 2.16 | 0.096 |
DM | ||||
Yes | 1.49 | 0.86 | 2.58 | 0.160 |
No | 1.77 | 1.29 | 2.44 | 0.001 |
ESRD | ||||
Yes | 3.32 | 0.89 | 12.44 | 0.075 |
No | 1.69 | 1.27 | 2.25 | <0.001 |
Liver cirrhosis | ||||
Yes | 1.86 | 0.46 | 7.59 | 0.387 |
No | 1.73 | 1.31 | 2.30 | <0.001 |
Autoimmune disease | ||||
Yes | 0.19 | 0.03 | 1.53 | 0.119 |
No | 1.87 | 1.41 | 2.47 | <0.001 |
Obesity | ||||
Yes | 1.88 | 0.35 | 9.96 | 0.461 |
No | 1.78 | 1.34 | 2.36 | <0.001 |
Tonsillectomy or adenotonsillectomy | ||||
Yes | 0.34 | 0.03 | 4.42 | 0.408 |
No | 1.74 | 1.31 | 2.31 | <0.001 |
Variables | Adjusted | 95% CI | p-Value | |
---|---|---|---|---|
HR | ||||
Main model * | ||||
Treatment | 1.71 | 1.15 | 2.54 | 0.009 |
Non-treatment | 1.76 | 1.25 | 2.46 | 0.001 |
Full model # | ||||
Treatment | 1.66 | 1.08 | 2.55 | 0.020 |
Non-treatment | 1.74 | 1.24 | 2.45 | 0.001 |
Additional covariates † | ||||
Main model + DM | ||||
Treatment | 1.68 | 1.13 | 2.50 | 0.011 |
Non-treatment | 1.72 | 1.23 | 2.42 | 0.002 |
Main model + ESRD | ||||
Treatment | 1.71 | 1.15 | 2.55 | 0.008 |
Non-treatment | 1.77 | 1.26 | 2.48 | 0.001 |
Main model + LC | ||||
Treatment | 1.71 | 1.15 | 2.55 | 0.008 |
Non-treatment | 1.75 | 1.25 | 2.45 | 0.001 |
Main model + autoimmune disease | ||||
Treatment | 1.70 | 1.14 | 2.53 | 0.009 |
Non-treatment | 1.74 | 1.24 | 2.43 | 0.001 |
Main model + obesity | ||||
Treatment | 1.76 | 1.18 | 2.63 | 0.006 |
Non-treatment | 1.80 | 1.28 | 2.53 | 0.001 |
Main model + tonsillectomy | ||||
Treatment | 1.64 | 1.07 | 2.50 | 0.023 |
Non-treatment | 1.75 | 1.25 | 2.46 | 0.001 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Ding, M.-C.; Hsu, C.-M.; Liu, S.Y.-C.; Lee, Y.-C.; Yang, Y.-H.; Liu, C.-Y.; Chang, G.-H.; Tsai, Y.-T.; Lee, L.-A.; Yang, P.-R.; et al. Deep Neck Infection Risk in Patients with Sleep Apnea: Real-World Evidence. Int. J. Environ. Res. Public Health 2021, 18, 3191. https://doi.org/10.3390/ijerph18063191
Ding M-C, Hsu C-M, Liu SY-C, Lee Y-C, Yang Y-H, Liu C-Y, Chang G-H, Tsai Y-T, Lee L-A, Yang P-R, et al. Deep Neck Infection Risk in Patients with Sleep Apnea: Real-World Evidence. International Journal of Environmental Research and Public Health. 2021; 18(6):3191. https://doi.org/10.3390/ijerph18063191
Chicago/Turabian StyleDing, Meng-Chang, Cheng-Ming Hsu, Stanley Yung-Chuan Liu, Yi-Chan Lee, Yao-Hsu Yang, Chia-Yen Liu, Geng-He Chang, Yao-Te Tsai, Li-Ang Lee, Pei-Rung Yang, and et al. 2021. "Deep Neck Infection Risk in Patients with Sleep Apnea: Real-World Evidence" International Journal of Environmental Research and Public Health 18, no. 6: 3191. https://doi.org/10.3390/ijerph18063191