Deep Neck Infection Risk in Patients with Sleep Apnea: Real-World Evidence

Meng-Chang Ding, Cheng-Ming Hsu, Stanley Yung-Chuan Liu, Yi-Chan Lee, Yao-Hsu Yang, Chia-Yen Liu, Geng-He Chang, Yao-Te Tsai, Li-Ang Lee, Pei-Rung Yang, Hsueh-Yu Li and Ming-Shao Tsai
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Meng-Chang Ding: Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Cheng-Ming Hsu: Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Stanley Yung-Chuan Liu: Division of Sleep Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA
Yi-Chan Lee: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Yao-Hsu Yang: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Chia-Yen Liu: Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Geng-He Chang: Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Yao-Te Tsai: Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
Li-Ang Lee: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Pei-Rung Yang: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Hsueh-Yu Li: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Ming-Shao Tsai: Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan

IJERPH, 2021, vol. 18, issue 6, 1-10

Abstract: (1) Background: Sleep apnea may be a risk factor for deep neck infection (DNI). The objective of this study was to investigate the effects of sleep apnea on DNI. (2) Methods: In this first nationwide retrospective cohort study on the sleep apnea–DNI correlation, we obtained data from the Longitudinal Health Insurance Database 2005, a subset of the Taiwan National Health Insurance Research Database. Patients who were newly diagnosed with sleep apnea between 1997 and 2012 were identified, and patients without sleep apnea were matched at a 1:4 ratio in age, sex, socioeconomic status, and urbanization level. The primary outcome of this study was DNI occurrence. The treatment modalities for sleep apnea and the comorbidities that occurred during the study period were also analyzed. (3) Results: Our sleep apnea and comparison (non-sleep apnea) cohorts comprised 6114 and 24,456 patients, respectively. We compared the cumulative incidence of DNI between these cohorts and found a greater incidence of DNI in the sleep apnea cohort ( p < 0.001). A strong sleep apnea–DNI association was found following analysis via the adjusted Cox proportional-hazards model (full model hazard ratio, 1.71; 95% confidence interval, 1.28–2.28; p < 0.001). In the subgroup analysis, sleep apnea increased DNI risk in men, in those aged < 50 years, and in those without diabetes mellitus, end-stage renal disease, liver cirrhosis, autoimmune disease, obesity, tonsillectomy, or adenotonsillectomy. (4) Conclusions: Our results confirmed sleep apnea to be an independent risk factor for DNI. Physicians should be aware of the potential occurrence of DNI in patients with sleep apnea.

Keywords: sleep apnea; sleep disturbance; snoring; deep neck infection; abscess; cellulitis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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