Obstructive sleep apnea increases the risk of herpes zoster and postherpetic neuralgia

ABSTRACT

Objective

Diseases associated with chronic pain are typically a major source of stress for patients; and have been linked to herpes zoster (HZ) development. Here, we investigated whether obstructive sleep apnea (OSA) is a potential stressor that increases the risk of HZ and postherpetic neuralgia (PHN) in affected individuals.

Methods

The data used in this study were obtained from the National Health Insurance Research Database. The study cohort included patients aged between 20 and 100 years who had OSA during the period from 2000 to 2017 (with tracking completed until 2018). The case group and the control group were matched at a 1:1 ratio on the basis of age, sex, comorbidities, and index year, with patients who had outcomes before the index date being excluded. The outcomes considered in this study were HZ and PHN. The risk of HZ and PHN with and without OSA was calculated, and age, sex, comorbidities, and index year were adjusted for.

Results

There were 25,211 patients in each group. Patients with OSA had a significantly higher risk of HZ (adjusted hazard ratio [aHR] = 1.22) than those without did. The patients with OSA had also a significantly higher risk of PHN (aHR = 1.36) than those without did. In term of comorbidities, the patients with OSA without (aHR = 1.28) and with (aHR = 1.17) comorbidities had a significantly higher risk of HZ compared with those without OSA. In addition, the patients with OSA but no other comorbidities (aHR = 1.68) had a significantly higher risk of PHN than those without did.

Conclusion

OSA increases the risk of not only HZ but also PHN. Therefore, patients with OSA should be aware of the potential effect of the disease on their stress levels, as well as the increased risk of developing HZ and PHN.

KEYWORDS:

• Obstructive sleep apnea
• herpes zoster
• postherpetic neuralgia
• hypoxia
• varicella zoster virus

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors are grateful to the staff at the Health Data Science Center, China Medical University Hospital, Taichung, Taiwan, for their assistance in providing administrative and technical support.

Author contributions

Chih-An Wang: conceptualization, methodology, project administration, writing- original draft. Wen-Che Hsieh: conceptualization, methodology, project administration, writing- original draft. Tzu-Ju Hsu: conceptualization, methodology, formal analysis, project administration. Fuu-Jen Tsai: conceptualization, methodology, project administration. Chao-Yu Hsu: conceptualization, methodology, project administration, writing- review and editing, supervision.

Ethics statement

This study was approved by the Institutional Review Board of the Research Ethics Committee of China Medical University Hospital, Taichung, Taiwan (CMUH111-REC2-109). As the patient information used in this study was de-identified and obtained from the National Health Insurance Research Database, the Institutional Review Board of China Medical University Hospital, Taichung, Taiwan waived the requirement for informed consent.

Data availability statement

The data utilized in this study were obtained from the National Health Insurance Research Database, which was provided by the Taiwan National Health Insurance Administration. Due to the Personal Data Protection Act, the data cannot be disclosed publicly. However, researchers can apply for access to the data for research purposes through the website of Taiwan National Health Insurance Administration (http://nhird.nhri.org.tw).

Additional information

Funding

This study was supported in part by Taiwan Ministry of Health and Welfare Clinical Trial Center [MOHW112-TDU-B-212-144004] and China Medical University Hospital [DMR-112-087].