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J Clin Sleep Med. 2019 Feb 15;15(2):275-283. doi: 10.5664/jcsm.7632.

Obstructive Sleep Apnea in Children and Adolescents and the Risk of Major Adverse Cardiovascular Events: A Nationwide Cohort Study in Taiwan.

Tzeng NS1,2, Chung CH3,4,5, Chang HA1,2, Chang CC1, Lu RB6,7, Yeh HW1,8,9,10, Chiang WS1, Kao YC1,11, Chang SY12,13, Chien WC3,4,14.

Author information

1
Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.
2
Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC.
3
Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
4
School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
5
Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC.
6
Department of Psychiatry, College of Medicine and Hospital, National Cheng-Kung University, Tainan, Taiwan, ROC.
7
Institute of Behavioral Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan, ROC.
8
Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan, ROC.
9
Department of Nursing, Tri-Service General Hospital, and School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC.
10
Department of Nursing, Kang-Ning University (Taipei Campus), Taipei, Taiwan, ROC.
11
Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, ROC.
12
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
13
Graduate Institute of Medical Sciences, National Defense Medical Center, Taiwan, ROC.
14
Graduate Institute of Life Sciences, National Defense Medical Center, Taiwan, ROC.

Abstract

STUDY OBJECTIVES:

This study has investigated the risk of major adverse cardiovascular events (MACEs), including acute myocardial infarction, coronary artery disease, peripheral artery disease, and acute stroke, among children and adolescents (age younger than 20 years) with obstructive sleep apnea (OSA).

METHODS:

In this study, the population-based National Health Insurance Research Database of Taiwan was used to identify patients in whom OSA had been first diagnosed between 2000 and 2015. Children and adolescents with OSA (n = 6,535) were included with 1:3 ratio by age, sex, and index year of control participants without OSA (n = 19,605). The Cox proportional regression model was used to evaluate the risk of MACEs in this cohort study.

RESULTS:

After a 15-year follow-up, the incidence rate of MACEs was higher in the OSA cohort when compared with the non-OSA control cohort (15.97 and 8.20 per 100,000 person-years, respectively). After adjusting for covariates, the risk of MACEs among children and adolescents with OSA was still significantly higher (hazard ratio = 2.050; 95% confidence interval = 1.312-3.107; P = .010). No MACEs were found in the children and adolescents with OSA who received continuous airway positive pressure treatment or pharyngeal surgery.

CONCLUSIONS:

This study found a significantly higher risk of MACEs in children and adolescents with OSA. These findings strongly suggest that clinicians should provide careful follow-up and medical treatment for children and adolescents with OSA.

KEYWORDS:

National Health Insurance Research Database; cohort study; major adverse cardiovascular events; sleep apnea

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