title: Management and Risk Reduction of Rheumatoid Arthritis in Individuals with Obstructive Sleep Apnea: A Nationwide Population-Based Study in Taiwan.
abstract: To explore associations between obstructive sleep apnea (OSA) and autoimmune diseases and evaluate whether OSA management reduces the incidence of autoimmune diseases.
  
  
  
  This was a retrospective cohort study using nationwide database research. The data was from 105,846 adult patients in whom OSA was diagnosed and recorded in the Taiwan National Health Insurance Research Database between 2002 and 2011 were the patients were analyzed retrospectively. Patients with antecedent autoimmune diseases were excluded. A comparison cohort of 423,384 participants without OSA served as age- and sex-matched controls. Multivariable Cox regression analysis was performed on both cohorts to compute risk of autoimmune diseases during follow-up. Time-dependent OSA treatment effect was analyzed among patients with OSA. There were no interventions.
  
  
  
  Among patients with OSA, overall risk for incident autoimmune diseases was significantly higher than that in controls (adjusted hazard ratio [HR] = 1.95, 95% confidence interval [CI] = 1.66-2.27). Risk for individual autoimmune diseases, including rheumatoid arthritis (RA), Sjögren syndrome (SS), and Behçet disease, was significantly higher in patients with OSA than in controls (HRs [95% CI]: RA 1.33 [1.03-1.72, SS 3.45 [2.67-4.45] and Behçet disease 5.33 [2.45-12.66]). Increased risk for systemic lupus erythematosus (HR 1.00 [0.54-1.84]) and systemic sclerosis (HR 1.43 [0.51-3.96]) did not reach statistical significance. Patients with OSA receiving treatment had an overall reduced risk of RA and other autoimmune diseases (time-dependent HRs [95% CI]: 0.22 [0.05-0.94] and 0.51 [0.28-0.92], respectively).
  
  
  
  Patients with OSA are associated with higher risk for developing RA, SS, and Behçet disease. OSA management is associated with reduced risk of RA.
authors.affiliation: Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan and Faculty of Medicine, National Yang-Ming University.|Institute of Clinical Medicine, National Yang Ming University, Taiwan.
authors.forename: Wei-Sheng
authors.initials: WS
authors.lastname: Chen
authors.affiliation: Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Chang
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taiwan.|Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taiwan.
authors.forename: Chi-Ching
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan and Faculty of Medicine, National Yang-Ming University.|Institute of Clinical Medicine, National Yang Ming University, Taiwan.|National Defense Medical Center, Taipei, Taiwan.
authors.forename: Deh-Ming
authors.initials: DM
authors.lastname: Chang
authors.affiliation: Biostatistics Center, College of Management, Taipei Medical University.
authors.forename: Yi-Hsuan
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan and Faculty of Medicine, National Yang-Ming University.
authors.forename: Chang-Youh
authors.initials: CY
authors.lastname: Tsai
authors.affiliation: Biostatistics Center and School of Health Care Administration, College of Management, Taipei Medical University.
authors.forename: Jin-Hua
authors.initials: JH
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000628:therapy*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000628:therapy*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Behçet disease; Sjögren syndrome; autoimmune disease; obstructive sleep apnea; rheumatoid arthritis