title: Obstructive sleep apnea is associated with liver disease: a population-based cohort study.
abstract: BACKGROUND
  The association between obstructive sleep apnea (OSA) and the risk of liver disease is unclear. Moreover, population-based studies on the risk of liver disease among people with OSA have not yet been conducted. This study aimed to investigate the risk of subsequent development of liver disease among people with OSA.
  
  
  METHODS
  Using Taiwan National Health Insurance claims data, this study collected subjects from a cohort of 17,374 people with OSA who were diagnosed between 2000 and 2008. A control group of 69,496 people was selected from the same database and matched by age, gender, urbanization, income, and date of initial admission. All subjects were followed up until 2010. Liver disease incidence and risk were calculated.
  
  
  RESULTS
  The overall risk of liver disease among people with OSA was significantly higher than in the control group (aHR = 5.52, p <0.001). Non-alcoholic fatty liver disease, cirrhosis, and hepatitis C had significant aHRs of 5.29, 7.50, and 7.19 (all at p <0.001), respectively. In contrast, hepatitis B had the smallest aHR of 3.71.
  
  
  CONCLUSIONS
  The risk of liver disease was more than five times higher among people with OSA compared with the control group; this was particularly for cirrhosis and hepatitis C. Liver disease is thus a very important health issue among people with OSA.
authors.affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Health Risk Management, College of Management, China Medical University, Taichung, Taiwan.
authors.forename: Tzu-Chieh
authors.initials: TC
authors.lastname: Chou
authors.affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Graduate Institute of Biostatistics, Biostatistics Center, College of Management, China Medical University, Taichung, Taiwan.
authors.forename: Wen-Miin
authors.initials: WM
authors.lastname: Liang
authors.affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Chang-Bi
authors.initials: CB
authors.lastname: Wang
authors.affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Nursing, College of Medicine and Nursing, Hunguang University, Taichung, Taiwan. Electronic address: tnwu@sunrise.hk.edu.tw.
authors.forename: Trong-Neng
authors.initials: TN
authors.lastname: Wu
authors.affiliation: Department of Respiratory Therapy, College of Health Care, China Medical University, Taichung, Taiwan; Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Healthcare Administration, Asia University, Taichung, Taiwan. Electronic address: lungwen.hang@gmail.com.
authors.forename: Liang-Wen
authors.initials: LW
authors.lastname: Hang
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology / Q000209:etiology; D006526:Hepatitis C / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*
keywords: Cirrhosis; Hepatitis B; Hepatitis C; Liver disease; Non-alcoholic fatty liver disease; Obstructive sleep apnea