Sleep Apnea and Risk of Peptic Ulcer Bleeding: A Nationwide Population-based Study

OBJECTIVE: Patients with sleep apnea sustain cessation of breath during sleep, leading to intermittent hypoxia, systemic inflammation, and sympathetic activation. These insults may contribute to initiation or progression of peptic ulcers. This retrospective matched-control cohort study explored the relationship of sleep apnea and subsequent development of peptic ulcer bleeding. METHODS: From 2000 to 2009, patients with newly diagnosed sleep apnea were identified from the Taiwan National Health Insurance Research Database. A control group without sleep apnea, matched for age, gender, comorbidities, and medications, was selected for comparison. In both groups, subjects with history of peptic ulcer bleeding, nonspecific gastrointestinal bleeding, or malignancy were excluded. The 2 cohorts were followed up and observed for occurrence of peptic ulcer bleeding. RESULTS: Of the 35,480 sampled patients (7096 patients with sleep apnea vs 28,384 controls), 84 (0.24%) experienced peptic ulcer bleeding during a follow-up period of 3.57 +/- 2.61 years, including 32 (0.45% of patients with sleep apnea) from the sleep apnea cohort and 52 (0.18% of control) from the control group (log-rank test, P < .0001). In comparison with subjects without development of peptic ulcer bleeding, those with peptic ulcer bleeding were older and had a higher percentage of sleep apnea, coronary artery disease, peptic ulcer, ischemic stroke, and medication for nonsteroidal anti-inflammatory drugs. By Cox regression analysis, sleep apnea, older age, and peptic ulcer history were independent predictors of peptic ulcer bleeding. Patients with sleep apnea experienced a 2.400-fold (95% confidence interval, 1.544-3.731; P < .001) higher risk for incident peptic ulcer bleeding after adjusting for other variables. CONCLUSIONS: Sleep apnea may be an independent risk factor for peptic ulcer bleeding. (C) 2013 Elsevier Inc. All rights reserved. The American Journal of Medicine (2013) 126, 249-255