title: Sleep apnea and risk of aortic dissection: A nonrandomized, pair-matched cohort study.
abstract: BACKGROUND
  Sleep apnea (SA) was associated with increased prevalence of aortic dissection (AD) in studies that were criticized for either their small sample size or lack of prospective observation. Using a considerably larger nationwide, population-based database and a long-term prospective cohort design, our study strived to explore the relationship between SA and the subsequent development of AD.
  
  
  METHODS
  From 2000 to 2007, we gathered a study cohort consisting of 15,848 newly diagnosed cases of SA from Taiwan's National Health Insurance Research Database. For the control group, another 39,826 individuals without SA were matched for age, sex, and comorbidity. The two cohorts were followed-up to observe the occurrence of AD.
  
  
  RESULTS
  During an average 3.59 ± 2.41 years of follow-up, we observed 33 cases of new AD occurrence [non-SA (22, 0.1%) vs. SA (11, 0.1%), p=0.669], and the incidence of AD was similar for both groups. After adjusting for age, sex, and comorbidity, only age [hazard ratio (HR) 1.03; 95% confidence interval (CI), 1.01-1.06; p=0.006], male gender (HR 2.49; 95% CI, 1.07-5.79; p=0.034), and hypertension (HR 6.28; 95% CI, 2.36-16.67; p<0.001) were independently associated with AD diagnosis.
  
  
  CONCLUSIONS
  SA was not associated with an increased risk of AD using a large nationwide cohort database. Nonetheless, larger prospective studies or meta-analyses are recommended to confirm our findings.
authors.affiliation: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Hsin-I
authors.initials: HI
authors.lastname: Teng
authors.affiliation: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Chin-Chou
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chiang
authors.affiliation: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Po-Hsun
authors.initials: PH
authors.lastname: Huang
authors.affiliation: Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, ROC.
authors.forename: Chia-Min
authors.initials: CM
authors.lastname: Chung
authors.affiliation: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Jaw-Wen
authors.initials: JW
authors.lastname: Chen
authors.affiliation: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Hsin-Bang
authors.initials: HB
authors.lastname: Leu
authors.affiliation: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Wan-Leong
authors.initials: WL
authors.lastname: Chan
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: 2012cvman@gmail.com.
authors.forename: Chiu-Yang
authors.initials: CY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000209:etiology*; D001014:Aortic Aneurysm / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D012891:Sleep Apnea Syndromes / Q000150:complications*
keywords: aortic dissection; sleep apnea