The effect of sex and age on the comorbidity burden of OSA: an observational analysis from a large nationwide US health claims database

Abstract

Obstructive sleep apnoea (OSA) is a highly prevalent condition but studies exploring the burden of OSA-associated comorbidities have been limited by small sample sizes with underrepresentation of women.We queried the Truven Health MarketScan Research Databases 2003-2012, which is a collection of health insurance claims for working adults and retirees with employer-sponsored health insurance. Adults with a diagnostic code for OSA with at least 12 months of follow-up from the index date of OSA diagnosis were compared to a matched random sample. Comorbidities were assessed using International Classification of Diseases, Ninth Edition, codes. A logistic regression model was constructed to test the independent association between OSA and comorbidities.Our cohort included 1,704,905 patients with OSA and 1,704,417 matched controls. All comorbidities were significantly more prevalent in OSA patients. Type 2 diabetes and ischaemic heart disease were more prevalent in men but hypertension and depression were more prevalent in women with OSA. In contrast, the sex differences in the prevalence of congestive heart failure, arrhythmias and stroke were less pronounced. The prevalence of comorbidities increased with age but the effect of age varied based on the specific comorbidity. The divergence between OSA and controls was more pronounced after the sixth decade of life for most cardiovascular diseases (i.e.heart failure, ischaemic heart disease, stroke and arrhythmias), while depression exhibited an opposite trend. In a fully adjusted model, the odds of all comorbidities were significantly increased in OSA patients.In a large, nationally representative sample of working and retired people, OSA is strongly associated with significant comorbidities in both men and women with unique sex differences emerging.

Effect on Intermittent Hypoxia on Plasma Exosomal Micro RNA Signature and Endothelial Function in Healthy Adults

“…The presence of altered concentrations, cell sources, and intrinsic properties of circulating microvesicles have been previously noted by several investigators in the context of OSA, whereby the ability of these microvesicles to induce coagulation, angiogenesis, and cell adhesion was noted, and globally believed to reflect a proatherogenic state. 9,[42][43][44][45] The enhanced pro-atherogenic state of OSA is further exemplified by not only the high cardiovascular morbidity burden of this condition, 46 but also by the elevated prevalence of peripheral vascular disease in OSA patients, 47 and multiple investigators have explored the vascular consequences of OSA in different settings. [48][49][50] Our study relied on healthy young adults subjected to a relatively brief IH exposure, such that we can only infer that more chronic exposures to IH in the context of OSA may further exacerbate the pathological changes induced by the disease, and hypothesize that the exosome-related activity on the endothelium will contribute to such processes, as illustrated by the current in vitro experiments.…”

Deriving information from external Big Databases and Big Data analytics: all that glitters is not gold

“…In this issue of the European Respiratory Journal, MOKHLESI et al [6] report the results of an interesting study that clearly shows some of the advantages and disadvantages of the use of large external databases that were not created for scientific purposes. This study used the MarketScan database (Truven Health Analytics, Ann Arbor, MI, USA), which holds information on 77.8 million working adults and retirees with employer-sponsored health insurance.…”

“…There is still no generally accepted definition of Big Data but a good approximation would be "large volumes of high-velocity, complex and variable data that require advanced techniques and technologies to enable the capture, storage, distribution, management and analysis of the information" [8]. According to this definition, the study by MOKHLESI et al [6] cannot be fully considered a Big Data study because although the authors use a very "big" database, they do use the customary statistical tests to analyse their data. It has now been established that the average patient is capable of generating around 2 gigabytes of potentially analysable information, while an average hospital that in 2010 was handling an annual rate of 150-200 terabytes of information would deal with 600-700 terabytes in 2015 and would expect the rate of growth to be even faster in the future [9].…”

Perfil De Pacientes Com Queixas De Distúrbios Respiratórios Relacionados Ao Sono

“…A síndrome da apneia obstrutiva do sono (SAOS) é um distúrbio respiratório relacionado ao sono altamente prevalente, afetando aproximadamente quatro porcento dos indivíduos adultos do gênero masculino e dois porcento do feminino e caracterizada pelo recorrente colapso sono-induzido das vias respiratórias faríngeas, levando à hipoxemia e hipercapnia (1)(2) . A obesidade é comum na SAOS e está associada ao aumento da gravidade da apneia do sono como indicado pelo índice de apneia/hipopneia (IAH).…”