Risk of obstructive sleep apnoea in patients with rheumatoid arthritis: a nationwide population-based retrospective cohort study

BackgroundNeither the incidence of indications for childhood tonsillectomy nor the proportion of tonsillectomies that are evidence-based is known.AimTo determine the incidence of indications for tonsillectomy in UK children, and the proportion of tonsillectomies meeting evidence-based criteria.Design and settingA retrospective cohort study of electronic medical records of children aged 0–15 years registered with 739 UK general practices contributing to a research database.MethodChildren with recorded indications for tonsillectomy were identified from electronic medical records. Evidence-based indications included documented sore throats of sufficient frequency and severity (Paradise criteria); periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome (PFAPA); or tonsillar tumour. Other indications were considered non-evidence-based. The numbers of children subsequently undergoing tonsillectomy was then identified. The numbers with evidence-based and non-evidence-based indications for surgery among children who had undergone tonsillectomy were determined.ResultsThe authors included 1 630 807 children followed up for 7 200 159 person–years between 2005 and 2016. Incidence of evidence-based indications for tonsillectomy was 4.2 per 1000 person years; 13.6% (2144/15 760) underwent tonsillectomy. Incidence of childhood tonsillectomy was 2.5 per 1000 person years; 11.7% (2144/18 281) had evidence-based indications, almost all with Paradise criteria. The proportion of evidence-based tonsillectomies was unchanged over 12 years. Most childhood tonsillectomies followed non-evidence-based indications: five to six sore throats (12.4%) in 1 year, two to four sore throats (44.6%) in 1 year, sleep disordered breathing (12.3%), or obstructive sleep apnoea (3.9%).ConclusionIn the UK, few children with evidence-based indications undergo tonsillectomy and seven in eight of those who do (32 500 of 37 000 annually) are unlikely to benefit.

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Is sleep apnoea a risk factor for Covid-19? Findings from a retrospective cohort study

10.1101/2020.05.14.20098319 ◽

2020 ◽

Cited By ~ 4

Author(s):

Thijs Feuth ◽

Tarja Saaresranta ◽

Antti Karlsson ◽

Mika Valtonen ◽

Ville Peltola ◽

...

Keyword(s):

Critical Care ◽

Risk Factor ◽

Cohort Study ◽

Oxygen Saturation ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Sleep Apnoea ◽

Study Data ◽

University Hospital ◽

Obstructive Sleep

Background: In the early phase of the coronavirus disease-19 (Covid-19) pandemic, Southwest Finland remained relatively spared. By the 3rd of May 2020, a total of 28 patients have been admitted to the Turku University Hospital. In this paper, we explore baseline characteristics in order to identify risk for severe Covid-19 disease and critical care admission. Methods For this retrospective cohort study, data were derived from hospital records. Basic descriptive statistics were used to characterise patients, including medians, percentiles and frequencies. Differences were tested with Mann Whitney U-test and Pearson's chi-square test. Results Pre-existent obstructive sleep apnoea (OSA) was present in 29% of patients admitted in the hospital for Covid-19, none of them having severe OSA. Overall, other findings on admission were comparable with those reported elsewhere. C-reactive protein (CRP) and procalcitonin (PCT) were higher in patients who were eventually transferred to critical care in comparison to in those who were not (median CRP 187 mg/L versus 52 mg/L, p<0.005 and median PCT 0.46 versus 0.12, p=0.047). Moreover, there was a trend towards lower oxygen saturation on admission in ICU-patients (87% versus 93%, p=0.09). Discussion OSA was pre-existent in a disproportional large group of patients, which suggests that it is an important risk factor for severe Covid-19. Furthermore, we identified high CRP, PCT and possibly oxygen saturation as useful clinical measures to identify patients at risk for critical care.

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Increased risk of obstructive sleep apnoea in women with polycystic ovary syndrome: a population-based cohort study

Acta Endocrinologica ◽

10.1530/eje-18-0693 ◽

2019 ◽

Vol 180 (4) ◽

pp. 265-272 ◽

Cited By ~ 6

Author(s):

Balachandran Kumarendran ◽

Dana Sumilo ◽

Michael W O’Reilly ◽

Konstantinos A Toulis ◽

Krishna M Gokhale ◽

...

Keyword(s):

Cohort Study ◽

Polycystic Ovary Syndrome ◽

Obstructive Sleep Apnoea ◽

Polycystic Ovary ◽

Population Based ◽

Sleep Apnoea ◽

Ovary Syndrome ◽

Obstructive Sleep ◽

Increased Risk

Objective Obesity is very common in patients with obstructive sleep apnoea (OSA) and polycystic ovary syndrome (PCOS). Longitudinal studies assessing OSA risk in PCOS and examining the role of obesity are lacking. Our objective was to assess the risk of OSA in women with vs without PCOS and to examine the role of obesity in the observed findings. Design Population-based retrospective cohort study utilizing The Health Improvement Network (THIN), UK. Methods 76 978 women with PCOS and 143 077 age-, BMI- and location-matched women without PCOS between January 2000 and May 2017 were identified. Hazard ratio (HR) for OSA among women with and without PCOS were calculated after controlling for confounding variables using multivariate Cox models. Results Median patient age was 30 (IQR: 25–35) years; median follow-up was 3.5 (IQR: 1.4–7.1) years. We found 298 OSA cases in PCOS women vs 222 in controls, with incidence rates for OSA of 8.1 and 3.3 per 10 000 person years, respectively. Women with PCOS were at increased risk of developing OSA (adjusted HR = 2.26, 95% CI: 1.89–2.69, P < 0.001), with similar HRs for normal weight, overweight and obese PCOS women. Conclusions Women with PCOS are at increased risk of developing OSA compared to control women irrespective of obesity. Considering the significant metabolic morbidity associated with OSA, clinicians should have a low threshold to test for OSA in women with PCOS. Whether OSA treatment has an impact on PCOS symptoms and outcomes needs to be examined.

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Methotrexate might reduce ischemic stroke in patients with rheumatoid arthritis: a population‐based retrospective cohort study

International Journal of Rheumatic Diseases ◽

10.1111/1756-185x.13267 ◽

2018 ◽

Vol 21 (8) ◽

pp. 1591-1599 ◽

Cited By ~ 7

Author(s):

Hong‐Wei Tam ◽

Chyong‐Mei Chen ◽

Pui‐Ying Leong ◽

Chao‐Hsi Chen ◽

Yuan‐Chao Li ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Ischemic Stroke ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Population Based

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P098 Predicting delays in or failure to initiate CPAP therapy: A retrospective cohort study

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.142 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A52-A53

Author(s):

S Moore ◽

B Duce ◽

C Ellender ◽

C Hukins

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Sleep Apnoea ◽

Male Gender ◽

Significant Feature ◽

Cpap Therapy ◽

Indigenous Status ◽

Younger Age ◽

Obstructive Sleep

Abstract Background Suboptimal CPAP usage is associated with negative outcomes and inefficient use of medical resources. Demographic and polysomnographic characteristics are well established predictors of poor adherence, however the literature regarding patients who fail to initiate treatment is limited. This audit aimed to identify features associated with the delayed commencement or failure to initiate CPAP therapy. Methods A single institution, retrospective cohort study was performed. The cohort comprised adults with obstructive sleep apnoea prescribed CPAP between 2017 and 2018. The demographic, clinical and polysomnographic features of this cohort were identified. Comparisons were conducted between patients who initiated therapy and those who did not, as well as between early and delayed initiators of treatment, which was defined as uptake after one month. Multiple logistic regression was performed with significance defined as a p<0.05. Results 916 patients were identified. 38.2% of patients did not uptake prescribed CPAP, with male gender (p < 0.001), younger age (p=0.007) and lower pressure (p=0.016) identified as prognostic factors. Socioeconomic disadvantage (p=0.774) and Epworth Sleepiness Scale (p=0.111) were not associated with failure to start treatment. Of the 61.8% of patients who initiated CPAP therapy, 33% exhibited a delayed start to therapy, with indigenous status a significant feature of this cohort (p=0.002). Discussion A large portion of patients displayed either delayed commencement or failure to initiate CPAP therapy. Younger age, male gender and lower prescribed pressures were identified as negative predictive factors. These characteristics, as well as delayed treatment experienced in the indigenous population, provide focus points for intervention.

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