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

Study Questions:

Are patients with sleep apnea (SA) at higher risk for peptic ulcer bleeding?


This retrospective matched-control cohort study explored the relationship of SA and subsequent development of peptic ulcer bleeding. From 2000 to 2009, patients with newly diagnosed SA were identified from a Taiwan Research Database. A control group without SA was matched for age, gender, comorbidities, and medications (including aspirin and warfarin), and selected for comparison. In both groups, subjects with history of peptic ulcer bleeding, nonspecific gastrointestinal bleeding, or malignancy were excluded. The two cohorts were followed up and observed for occurrence of peptic ulcer bleeding.


Of the 35,480 sampled patients (7,096 patients with SA vs. 28,384 controls), 84 (0.24%) experienced peptic ulcer bleeding during a follow-up period, including 32 (0.45% of patients with SA) from the SA cohort and 52 (0.18% of control) from the control group (p < 0.0001). In comparison with subjects without development of peptic ulcer bleeding, those with peptic ulcer bleeding were older and had a higher percentage of SA, coronary artery disease, peptic ulcer, ischemic stroke, and medication for nonsteroidal anti-inflammatory drugs. By Cox regression analysis, SA, older age, and peptic ulcer history were independent predictors of peptic ulcer bleeding. Patients with SA experienced a 2.4-fold (95% confidence interval, 1.544-3.731; p< 0.001) higher risk for incident peptic ulcer bleeding after adjusting for other variables.


The authors concluded that SA may be an independent risk factor for peptic ulcer bleeding.


Activation of the sympathetic nervous system associated with SA may facilitate peptic ulcer bleeding in a similar manner as how stress-associated ulcers occur. However, the exact mechanism awaits further studies. Practitioners encountering patients with peptic ulcer bleeding without apparent cause may now screen for SA as a predisposing factor.

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Atherosclerotic Disease (CAD/PAD), Sleep Apnea

Keywords: Coronary Artery Disease, Stroke, Peptic Ulcer Hemorrhage, Warfarin, Risk Factors, Taiwan, Sleep Apnea Syndromes

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