title: The association between continuous positive airway pressure therapy and liver disease development in obstructive sleep apnea/hypopnea syndrome patients: a nationwide population-based cohort study in Taiwan.
abstract: OBJECTIVE
  Studies on the association between continuous positive airway pressure (CPAP) treatment and liver diseases such as non-alcoholic fatty liver disease (NAFLD) and cirrhosis in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) are limited. To the best of our knowledge, none exists that makes use of a national database in an Asian population. This study aims to evaluate the effects of CPAP treatment on patients with these two disorders in a retrospective, population-based study in Taiwan.
  
  
  METHODS
  Using the Taiwan National Health Insurance claims database, this study collected the data of OSAHS patients diagnosed between 2000 and 2008 and divided them into CPAP treatment and non-CPAP treatment groups. All subjects were followed up until 2010. Liver disease incidence and risk were calculated.
  
  
  RESULTS
  The CPAP group had a lower cumulative incidence rate of developing liver disease than the non-CPAP group within the observation periods (p < 0.001). After adjusting for age, gender, urbanization level, and comorbidities, the CPAP treatment group showed a lower risk of developing liver disease compared with the non-CPAP treatment group (sub-aHR of 0.66 (95% CI 0.55-0.80), p < 0.001).
  
  
  CONCLUSIONS
  Our observations suggest that CPAP treatment may play an important role to delay the progression of liver disease in OSAHS patients and decreases the incidence of liver disease among OSAHS patients. Thus, CPAP therapy may be a feasible way to decrease the risk of liver disease among patients with OSAHS.
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.
authors.forename: Liang-Wen
authors.initials: LW
authors.lastname: Hang
authors.affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Chi-Fung
authors.initials: CF
authors.lastname: Chen
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 Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
authors.forename: Trong-Neng
authors.initials: TN
authors.lastname: Wu
authors.affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan. wmliang.cmu@gmail.com.|Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan. wmliang.cmu@gmail.com.
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. choutc@mail.cmu.edu.tw.|Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan. choutc@mail.cmu.edu.tw.
authors.forename: Tzu-Chieh
authors.identifier: http://orcid.org/0000-0002-9634-0637
authors.initials: TC
authors.lastname: Chou
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology* / Q000517:prevention & control*; D057216:Propensity Score; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000628:therapy*; D013624:Taiwan
keywords: CPAP treatment; Cohort; Liver disease; OSAHS; Population-based study