Sleep Apnea Associated with Higher Risk of Peptic Ulcer Bleeding

A retrospective review of records from a large medical database finds that patients with sleep apnea face a substantially higher risk of developing peptic ulcer.

Researchers from the Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, reported that patients with sleep apnea face a substantially higher risk of developing peptic ulcer.

In “Sleep Apnea and Risk of Peptic Ulcer Bleeding: A Nationwide Population-based Study,” published in The American Journal of Medicine, the researchers noted that patients with sleep apnea “sustain cessation of breath during sleep, leading to intermittent hypoxia, systemic inflammation, and sympathetic activation,” which they suggest “may contribute to initiation or progression of peptic ulcers.”

To explore this concept, the authors identified a cohort of 7096 patients with newly diagnosed sleep apnea using records from the Taiwan National Health Insurance Research Database. They compared these patients to a group of 28,384 controls who had not been diagnosed with sleep apnea. The controls were matched for age, gender, comorbidities, and medications.

Patients with a history of peptic ulcer bleeding, nonspecific gastrointestinal bleeding, or gastrointestinal malignancy were excluded from both groups.

The authors of the study reported that 84 patients experienced peptic ulcer bleeding during multi-year follow up (32 patients with sleep apnea, 52 patients from the control group). Compared with patients who did not experience peptic ulcer bleeding, patients with peptic ulcer bleeding were older and had a higher percentage of sleep apnea, coronary artery disease, peptic ulcer, ischemic stroke, and medication use for nonsteroidal anti-inflammatory drugs.

Analysis of study data revealed sleep apnea, older age, and peptic ulcer history to be independent predictors of peptic ulcer bleeding.

The researchers wrote that “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.”