Yi Hua Chen

Obstructive sleep apnea and the risk of adverse pregnancy outcomes

OBJECTIVEnWe examined the risk of adverse pregnancy outcomes, including low birthweight (LBW), preterm birth, small for gestational age (SGA), cesarean section (CS), low Apgar score (at 5 minutes after delivery), and preeclampsia in pregnant women with and without obstructive sleep apnea (OSA).nnnSTUDY DESIGNnOur subjects included 791 women with OSA and 3955 randomly selected women without OSA. We performed conditional logistic regression analyses to examine the risks of adverse pregnancy outcomes between women with and without OSA.nnnRESULTSnCompared with women without OSA, adjusted odds ratios for LBW, preterm birth, SGA infants, CS, and preeclampsia in women with OSA were 1.76 (95% confidence interval [CI], 1.28-2.40), 2.31 (95% CI, 1.77-3.01), 1.34 (95% CI, 1.09-1.66), 1.74 (95% CI, 1.48-2.04), and 1.60 (95% CI, 2.16-11.26), respectively.nnnCONCLUSIONnPregnant women with OSA are at increased risk for having LBW, preterm, and SGA infants, CS, and preeclampsia, compared with pregnant women without OSA.

Increased Risk of Adverse Pregnancy Outcomes in Women Receiving Zolpidem During Pregnancy

This nationwide population‐based study was carried out in Taiwan with the aim of comparing the risk of adverse pregnancy outcomes in women who received zolpidem treatment for insomnia during pregnancy with that in women who did not. The adverse outcomes identified and assessed were delivery of low‐birth‐weight (LBW) infants, preterm deliveries, delivery of small‐for‐gestational‐age (SGA) infants, delivery of infants with congenital anomalies, and cesarean delivery. The incidences of these were compared between the groups after adjusting for other characteristics of the mothers and infants. The study used the Taiwan National Health Insurance Research Dataset (NHIRD) and birth‐certificate registry. In total, the data from 2,497 mothers who received zolpidem treatment during pregnancy and those from 12,485 randomly selected mothers who did not receive the drug were included in the analysis. The results show that the adjusted odds ratios (ORs) for adverse pregnancy outcomes—LBW infants, preterm deliveries, SGA infants, and cesarean delivery—were all higher in mothers who received zolpidem treatment during pregnancy, relative to the randomly selected controls (1.39 (95% confidence interval (CI) = 1.17–1.64), 1.49 (95% CI = 1.28–1.74), 1.34 (95% CI = 1.20–1.49), and 1.74 (95% CI = 1.59–1.90), respectively). In conclusion, the risk of adverse pregnancy outcomes was higher in women who received zolpidem during pregnancy than in those who did not.

Association between obstructive sleep apnoea and chronic periodontitis: a population‐based study

AIMnThis study set out to explore the association between obstructive sleep apnoea (OSA) and prior chronic periodontitis (CP) by utilizing a population-based data set with a case-control design in Taiwan.nnnMATERIALS AND METHODSnWe included 7673 subjects with OSA as cases, and randomly selected 21,963 subjects without a history of OSA as controls. We performed conditional logistic regression analyses to explore the association between OSA and having been previously diagnosed with CP.nnnRESULTSnThere was a significant difference in the prevalence of prior CP between cases and controls (33.8% versus 22.6%, pxa0<xa00.001). Conditional logistic regression analysis suggested that the odds ratio of prior CP for cases was 1.75 (95% CIxa0=xa01.68-1.88) times greater than that of controls after adjusting for monthly income and geographical location, as well as hypertension, diabetes, coronary heart disease, hyperlipidaemia, obesity, tobacco use disorder, and chronic obstructive pulmonary disease and alcohol abuse.nnnCONCLUSIONnOur study detected an association between OSA and a prior diagnosis of CP.

Pregnancy Outcomes of Anti-Hypertensives for Women with Chronic Hypertension: A Population-Based Study

Background The impact of anti-hypertensive treatment on fetus was unclear, and hence, remains controversial. We set out in this study to estimate the prevalence of adverse pregnancy outcomes, including low birth weight, preterm delivery and small for gestational age amongst women with chronic hypertension, and to determine whether the use of anti-hypertensive drugs increases the risk of such adverse pregnancy outcomes. Methodology/Principal Findings A total of 2,727 hypertension mothers and 8,181 matched controls were identified from the population-based cohort. These hypertension women were divided into seven sub-groups according to different types of prescribed anti-hypertensive drugs. Multivariable logistic regressions were conducted to estimate the risk of low birth weight, preterm birth and small for gestational age. Increased risk of low birth weight (ORu200a=u200a2.29, 95% CIu200a=u200a1.95–2.68), preterm birth (ORu200a=u200a2.18, 95% CIu200a=u200a1.89–2.52) and small for gestational age (ORu200a=u200a1.62, 95% CIu200a=u200a1.45–1.81) were all discernible within the hypertension group after adjusting for potential confounding factors. The increased ORs were found to differ with different types of anti-hypertensive drugs. Women who received vasodilators were associated with the highest risk of low birth weight (ORu200a=u200a2.96, 95% CIu200a=u200a2.06–4.26), preterm birth (ORu200a=u200a2.92 95% CIu200a=u200a2.06–4.15) and small for gestational age (ORu200a=u200a2.12, 95% CIu200a=u200a1.60–2.82). Conclusions/Significance This finding is important for practitioners, because it indicates the need for caution while considering the administration of anti-hypertensive drugs to pregnant women. These observations require confirmation in further studies that can better adjust for the severity of the underlying HTN.

Association between Traumatic Brain Injury and the Subsequent Risk of Brain Cancer

This population-based study in Taiwan aimed to investigate the risk of having a diagnosis of malignant brain tumors within 3 years after a traumatic brain injury (TBI). This study used data from the Traumatic Brain Injury Registry and the National Health Insurance Research Database. The study cohort comprised 5007 patients who had visited ambulatory care centers or had been hospitalized with a diagnosis of TBI between 2001 and 2002. The comparison cohort was 25,035 randomly selected enrollees. Each patients brain cancer status was individually tracked for a 3-year period following their index date. Stratified Cox proportional hazards regressions were performed for analyses. During the 3 years of follow-up, nine patients in each cohort, both the TBI and the non-TBI cohort, were diagnosed with brain cancer. As compared to those patients without TBI, patients with TBI were more likely to receive a diagnosis of malignant brain tumors within the 3-year period following their index date: the incidence rate of malignant brain tumors was 6.28 (95% CI: 3.06-11.53) per 10,000 person-years in patients with TBI and 1.25 (95% CI: 0.61-2.29) per 10,000 person-years in patients without TBI. After adjusting for sociodemographic characteristics, the hazard of being diagnosed with malignant brain tumors during the 3-year follow-up period was 4.67 (95% CI: 1.84-11.83) times greater for those who sustained a TBI than for patients in the comparison cohort. In addition, we found an association between TBI severity and malignant brain tumor among patients with TBI (p=0.033). Our findings suggest a positive correlation between TBI and the relatively short-term development of malignant neoplasms of the brain.

Psychiatric diseases predated the occurrence of Parkinson disease: a retrospective cohort study

PURPOSEnThe influence of mental illness early in life on the subsequent risk of Parkinson disease (PD) and its clinical picture remain obscure. This study investigated the effects of psychiatric diseases on a subsequent PD diagnosis.nnnMETHODSnWe used the Longitudinal Health Insurance Database 2000 of Taiwan to identify 73,597 patients who visited ambulatory care centers or were hospitalized with a first-time diagnosis of anxiety, affective disorders, or schizophrenia between 2001 and 2003 as the study cohort. We also randomly selected 220,791 enrollees matched with the study cohort for comparison. Each patient was individually tracked for 6xa0years to identify a subsequent PD diagnosis. Stratified Cox proportional hazard regressions were performed for the analysis.nnnRESULTSnThe incidence rate of PD per 1000 person-years was 4.91 (95% confidence interval [CI], 4.71-5.12) and 1.63 (95% CI, 1.56-1.70) for the psychiatric and comparison groups, respectively. Patients with psychiatric illnesses were more vulnerable to developing PD than nonpsychiatric individuals, exhibiting a 2.38-fold increased risk (95% CI, 2.23-2.53) after other covariates were considered. Furthermore, patients with schizophrenia exhibited the highest risk for developing PD.nnnCONCLUSIONSnWe suggest effective monitoring of patients with psychiatric disturbances for potential long-term neurodegenerative diseases.

Urinary calculi increase the risk for adverse pregnancy outcomes: a nationwide study

Objective. Using two large‐scale nationwide population‐based data sets, this study aimed to assess the risk of adverse pregnancy outcomes between mothers with and without urinary calculi. Design. Cross‐sectional study. Setting. Taiwan. Sample. This study included 3694 women who had live singleton births and received a diagnosis of urinary calculi (UC) in the year prior to their delivery, as well as 18 470 matched women without UC, who were used as a comparison group. Methods. Conditional logistic regression analyses were performed. Main outcome measures. Low birthweight, preterm birth, small for gestational age, cesarean section, lower Apgar score and pre‐eclampsia/eclampsia. Results. Women with UC had a higher prevalence of low‐birthweight neonates (7.4 vs. 6.0%, p = 0.003), preterm births (9.5 vs. 7.3%, p < 0.001) and cesarean sections (43.1 vs. 35.4%, p < 0.001) than women without UC. After adjusting for potential confounding factors, women with UC were more likely than women without UC to have low‐birthweight neonates (odds ratio 1.21, 95% confidence interval 1.05–1.39), preterm birth (odds ratio 1.28, 95% confidence interval 1.13–1.43) and cesarean sections (odds ratio 1.37, 95% confidence interval 1.28–1.48). Conclusions. There were increased risks for having low‐birthweight, preterm infants and for experiencing cesarean section among women with UC in comparison to women without UC.

Adequate Prenatal Care Reduces the Risk of Adverse Pregnancy Outcomes in Women with History of Infertility: A Nationwide Population-Based Study

Objectives To investigate the effects of various measures of prenatal care on adverse pregnancy outcomes in women with a history of infertility. Study Design A retrospective cohort study. Methods Data were derived by linking 2 large nationwide population-based datasets, the National Health Insurance Research Database and Taiwan Birth Certificate Registry. The study sample included 15,056 women with an infertility diagnosis and 60,224 randomly selected women without infertility matched to the study sample by maternal age. A conditional logistic regression analysis was performed for the analysis. Results Women diagnosed with infertility respectively had 1.39 (95% CI, 1.06~1.83), 1.15 (95% CI, 1.08~1.24), 1.13 (95% CI, 1.08~1.18), and 1.08 (95% CI, 1.05~1.12) higher odds of having very low birth weight (VLBW) babies, preterm births, labor complications, and cesarean sections (CSs) compared to women without infertility. Inadequate numbers of total and major prenatal visits and late initiation of prenatal care increased the risks of adverse pregnancy outcomes in women with infertility, especially the risk of a VLBW baby. However, no significant associations were found for the risks of adverse birth outcomes in infertile women with adequate prenatal care compared to fertile women with adequate care. Conclusions Study findings suggest that adequate prenatal care can reduce the risk of adverse pregnancy outcomes in women with infertility.

A population-based case-control analysis of the association between Herpes Zoster and Erectile Dysfunction

PURPOSEnTo date, the occurrence of erectile dysfunction (ED) associating with herpes zoster (HZ) is only based on limited case reports. This case-control study aimed at examining the association between HZ and ED using a population-based dataset in Taiwan.nnnMETHODSnA total of 6429 adults newly diagnosed with ED were identified as cases, and 38,574 subjects without any medical history of ED were extracted as controls. Conditional logistic regression models were performed.nnnRESULTSnIn total, 1.03% out of the sampled subjects had been diagnosed with HZ within one year prior to the index date; a higher proportion of prior HZ was found among cases than controls (2.04% vs. 0.86%, p < 0.001). After adjusting for demographic characteristics, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome, conditional logistic regression suggested that cases were more likely to have previously been diagnosed with HZ than controls (OR = 2.24, 95% CI = 1.82-2.75). Furthermore, the odds of having been diagnosed with an HZ infection within one year prior to the index date were dramatically higher among patients with ED than controls among subjects aged 18-29 (OR = 6.07).nnnCONCLUSIONSnWe conclude that ED was associated with having been previously diagnosed with HZ, particularly among younger males.

Possible effects of anaesthetic management on the 1 yr followed-up risk of herpes zoster after Caesarean deliveries

BACKGROUNDnAs general anaesthesia may compromise the immune system, it has been hypothesized that latent varicella-zoster virus is more likely to be reactivated and cause herpes zoster in mothers after Caesarean deliveries under general anaesthesia. Our study was thus aimed at investigating the risk of herpes zoster among women during the first year after Caesarean deliveries under either general or regional anaesthesia.nnnMETHODSnTwo nationwide population-based data sets were utilized, including the Taiwan birth certificate registry and the Taiwan National Health Insurance Research Dataset. From 2001 to 2003, a total of 162 495 women underwent Caesarean delivery. Among them, 21 454 women received general anaesthesia, whereas 141 041 patients received regional anaesthesia. Each individual was followed for 1 yr to identify the subsequent occurrence of herpes zoster. Coxs proportional hazards regressions were performed for analysis.nnnRESULTSnDuring the 1 yr follow-up period, 0.46% of the women receiving general anaesthesia experienced an episode of herpes zoster, compared with 0.34% of women receiving regional anaesthesia. In Caesarean deliveries, the use of general anaesthesia compared with regional anaesthesia was independently associated with a 1.29-fold (95% confidence interval=1.04-1.61) increase in the 1 yr risk of herpes zoster, after adjusting for maternal and infant characteristics.nnnCONCLUSIONSnIn this series, there was a small increased risk of herpes zoster in the year after Caesarean delivery with general anaesthesia. Future studies are needed to further investigate these findings.