Association between septal deviation and OSA diagnoses: a nationwide 9-year follow-up cohort study

Sang Woo Yeom; Min Gul Kim; Eun Jung Lee; Sang Keun Chung; Doo Hwan Kim; Sang Jae Noh; Min Hee Lee; Yun Na Yang; Chan Mi Lee; Jong Seung Kim

doi:10.5664/jcsm.9352

Association between septal deviation and OSA diagnoses: a nationwide 9-year follow-up cohort study

J Clin Sleep Med. 2021 Oct 1;17(10):2099-2106. doi: 10.5664/jcsm.9352.

Authors

Sang Woo Yeom^{1

2}, Min Gul Kim^{3

4}, Eun Jung Lee^{1

3}, Sang Keun Chung^{3

5}, Doo Hwan Kim⁶, Sang Jae Noh^{3

7}, Min Hee Lee⁸, Yun Na Yang¹, Chan Mi Lee¹, Jong Seung Kim^{1

2

3}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea.
² Department of Medical Informatics, Jeonbuk National University, Jeonju, Republic of Korea.
³ Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
⁴ Department of Pharmacology, Jeonbuk National University, Jeonju, Republic of Korea.
⁵ Department of Psychiatry, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea.
⁶ Director of Big-Data Center, National Health Insurance Service (NHIS), Wonju, Republic of Korea.
⁷ Department of Forensic Medicine, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea.
⁸ Department of Internal Medicine, Division of Allergy and Pulmonology, Presbyterian Medical Center, Jeonju, Republic of Korea.

Abstract

Study objectives: Obstructive sleep apnea (OSA) is a multilevel problematic disease. Major septal deviation (SD) can lead to severe nasal congestion, which, in turn, can lead to sleep apnea. Although SD seems to be related to OSA, very few studies have quantitatively examined this relationship. In this study, we investigate this using a 9-year large-scale cohort study.

Methods: The SD group was selected out of 1 million individuals randomly extracted by the National Health Insurance Service. The non-SD group was obtained through propensity score matching considering several variables. The primary end point was OSA diagnosis.

Results: The study (SD) group included 11,238 individuals and the non-SD group (control group) included 22,476 persons. The overall hazard ratio for OSA in the SD group was 4.39 (95% confidence interval [CI]: 3.56-5.42). In subgroup analysis, the hazard ratio for OSA of male individuals was 3.77 (95% CI: 2.83-5.03), high economic status was 1.27 (95% CI: 1.05-1.56), metropolitan area was 1.31 (95% CI: 1.07-1.62), young age was 0.79 (95% CI: 0.64-0.98), hypertension was 1.00 (95% CI: 0.37-2.7), and diabetes mellitus was 2.44 (95% CI: 1.15-5.21). In the SD group, the hazard ratio for OSA after septoplasty was 0.71 (95% CI: 0.54-0.94).

Conclusions: From long-term follow-up, the prevalence of OSA was 4.39 times higher in the SD group compared with the control group. This phenomenon was more pronounced with increasing body mass index and decreased significantly after septoplasty.

Citation: Yeom SW, Chung SK, Lee EJ, et al. Association between septal deviation and OSA diagnoses: a nationwide 9-year follow-up cohort study. J Clin Sleep Med. 2021;17(10):2099-2106.

Keywords: cohort study; national health insurance service; obstructive sleep apnea; septal deviation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Follow-Up Studies
Humans
Male
Prevalence
Proportional Hazards Models
Risk Factors
Sleep Apnea, Obstructive* / diagnosis
Sleep Apnea, Obstructive* / epidemiology