Yang Tzong-Hann, Xirasagar Sudha, Cheng Yen-Fu, Wu Chuan-Song, Kao Yi-Wei, Shia Ben-Chang, Lin Herng-Ching
Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan; Department of Speech, Language and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, USA.
Sleep Med. 2020 Jul;71:54-58. doi: 10.1016/j.sleep.2020.03.025. Epub 2020 Apr 3.
The study objective was to evaluate the association between cervical spondylosis (CS) and a subsequent diagnosis of obstructive sleep apnea (OSA) in light of the expected constricting impact of CS-associated cervical spine changes on the pharyngeal airway space, a key contributor to OSA.
Data were retrieved from the Taiwan National Health Insurance Research Dataset. A total of 98,234 patients who newly received a diagnosis of OSA were identified. We identified four propensity score-matched controls per OSA patient (n = 392,936). Chi-square tests were used to compare cases and controls on sociodemographic characteristics, and multivariable logistic regression modelling to examine the association of OSA with prior CS.
Of the 98,234 sampled patients, 18,070 (18.4%) patients had a prior CS diagnosis, significantly different among cases compared to controls, being 18.4% and12.1%, respectively, p < 0.001. Logistic regression analysis showed an adjusted odds ratio (OR) of prior CS of 1.778 (95% confident interval (CI): 1.744-1.814) relative to controls. The adjusted odds of prior CS without myelopathy was 1.764 for cases relative to controls (95% CI: 1.727-1.801), and for prior CS with myelopathy (adjusted OR: 1.778, 95% CI: 1.721-1.837). Analysis stratified by age showed that in the 45-64- and >64-year age groups, the adjusted ORs of CS were 1.803 (95% CI: 1.758-1.850) and 1.634 (95% CI: 1.568-1.703), respectively, for cases relative to controls.
Our results suggest that OSA is associated with prior CS. The results call for professionals to be alert to the possibility of subsequent development of OSA among patients with CS.
鉴于颈椎病（CS）相关的颈椎改变对咽气道空间的预期收缩影响（咽气道空间是阻塞性睡眠呼吸暂停（OSA）的关键促成因素），本研究旨在评估颈椎病与后续阻塞性睡眠呼吸暂停诊断之间的关联。
数据取自台湾国民健康保险研究数据集。共识别出98234例新诊断为阻塞性睡眠呼吸暂停的患者。我们为每位阻塞性睡眠呼吸暂停患者确定了4个倾向评分匹配对照（n = 392936）。采用卡方检验比较病例组和对照组的社会人口学特征，并使用多变量逻辑回归模型检验阻塞性睡眠呼吸暂停与既往颈椎病之间的关联。
在98234例抽样患者中，18070例（18.4%）患者既往有颈椎病诊断，病例组与对照组有显著差异，分别为18.4%和12.1%，p < 0.001。逻辑回归分析显示，与对照组相比，既往颈椎病的调整优势比（OR）为1.778（95%置信区间（CI）：1.744 - 1.814）。与对照组相比，病例组既往无脊髓病的颈椎病调整优势比为1.764（95% CI：1.727 - 1.801），既往有脊髓病的颈椎病调整优势比为1.778（95% CI：1.721 - 1.837）。按年龄分层分析显示，在45 - 64岁和>64岁年龄组中，与对照组相比，病例组颈椎病的调整OR分别为1.803（95% CI：1.758 - 1.850）和1.634（95% CI：1.568 - 1.703）。
我们的结果表明，阻塞性睡眠呼吸暂停与既往颈椎病有关。该结果提醒专业人员警惕颈椎病患者后续发生阻塞性睡眠呼吸暂停的可能性。
