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Wang X, Song S, Dong N, Lv R, He Y, Zhao Y, Yue H. The causal relationship between depression and obstructive sleep apnea: A bidirectional Mendelian randomization study. J Psychosom Res 2024; 179:111620. [PMID: 38430795 DOI: 10.1016/j.jpsychores.2024.111620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/16/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Numerous studies have reported the close association of depression with obstructive sleep apnea (OSA). However, the causal nature and direction remain unclear. This study aimed to identify the genetic causal relationship between depression and OSA using Mendelian randomization (MR). METHODS Based on publicly available genome-wide association studies data of depression and OSA, we conducted a bidirectional two-sample MR study. The inverse-variance weighted (IVW) was used as the main analysis method. Moreover, multivariable MR was performed to further explore the underlying genetic causality of OSA and depression after adjusting for several potential mediators. RESULTS The univariable MR analysis revealed a significant causality of depression on the susceptibility of OSA (ORivw = 1.29, 95%CI:1.11,1.50; p < 0.001). This relationship was evidenced by the phenotypes for broad depression (ORivw = 3.30, 95%CI: 1.73, 6.29; p < 0.001), probable major depression (ORivw = 18.79, 95%CI: 5.69, 61.99; p < 0.001), and ICD-10 major depression (ORivw = 23.67, 95%CI: 4.13, 135.74; p < 0.001). In the reverse direction, no significant causal effect of OSA on depression was found. After adjusting for smoking, alcohol use, obesity, type 2 diabetes, insomnia, age, gender, and codeine, most of these results suggested that depression remained significantly and positively associated with OSA. CONCLUSION These findings may contribute to the understanding of the etiology of depression and OSA and also suggest the clinical significance of controlling depression for the prevention of OSA.
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Affiliation(s)
- Xiao Wang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Shaoming Song
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China; Faculty of Hepato-Biliary-Pancreatic Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Na Dong
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Renjun Lv
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Yao He
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Yan Zhao
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Hongmei Yue
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China; Department of Pulmonary and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China.
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Di Bello F, Pezone G, Muzii B, Cilio S, Ruvolo CC, Scandurra C, Mocini E, Creta M, Morra S, Bochicchio V, Salzano G, Vaira LA, Mangiapia F, Motta G, Maldonato NM, Longo N, Cantone E, Califano G. Lower urinary tract symptoms in young-middle aged males with a diagnosis of obstructive sleep apnea syndrome. Neurourol Urodyn 2024; 43:144-152. [PMID: 38010890 DOI: 10.1002/nau.25338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The aim of the current study is to measure the prevalence and the potential role of International Prostate Symptom Score (IPSS) score as a predictor of obstructive sleep apnea syndrome (OSAS) in male experienced lower urinary tract symptoms (LUTS). METHODS A cross-sectional web-based Italian survey was administered via Google Forms between July 17 and October 31, 2022. The urinary functioning was measured through the IPSS questionnaire. Specifically, we considered symptoms occurring more than "about half the time" (score ≥ 3) as bothering symptoms. Multivariable logistic regression models (LRMs) adjusting for age, body mass index (BMI), International Index of Erectile Function-5, IPSS, and hypertension were fitted to predict OSAS in the cohort of men responding to the survey and experiencing LUTS. RESULTS Overall, 58 (24.4%) patients had a confirmed diagnosis of OSAS. The overall median IPSS was 5 (inter quartile range [IQR]: 3-8), respectively. According to IPSS items, 24 (10%), 44 (18.4%), 12 (5%), 12 (5%), 12 (5%), 11 (4.6%), 63 (26.4%) patients exhibit incomplete bladder emptying, urinary frequency, intermittency, urgency, weak stream, straining, nocturia with a score ≥ 3, respectively. After multivariable LRMs predicting the developing OSAS, age (odds ratio [OR]: 1.09, p < 0.001), BMI (OR:1.12, p < 0.001) and IPSS total score (OR:1.08, p = 0.02) were independent predicting factors. CONCLUSION This analysis revealed that the IPSS total score, age, and BMI are independent predictors of OSAS in males. In this context, the use of IPSS in daily practice could be helpful in assessing the LUTS presence and in supporting physicians to identify a hidden sleep apnea condition.
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Affiliation(s)
- Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Gabriele Pezone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Benedetta Muzii
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Simone Cilio
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Cristiano Scandurra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Edoardo Mocini
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | | | - Giovanni Salzano
- Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Hospital of Naples "Federico II", Naples, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Francesco Mangiapia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Gaetano Motta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Nelson Mauro Maldonato
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
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Duco D, Niek W, Selene K, Stuart W, Nicolle C, Petal W, Marjolein D. Prevalence of interstitial and other lung diseases on Aruba. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 34:217-225. [PMID: 32476849 PMCID: PMC7170099 DOI: 10.36141/svdld.v34i3.6038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/27/2017] [Indexed: 11/07/2022]
Abstract
Background: Health care management has to be based on the local prevalence of diseases and the local diagnostic and therapeutic needs. So far, no systematic registration system for various lung diseases exists on Aruba. Questions that need to be answered are: what specific lung disorders occur on Aruba, and what are the specific needs there? The aim of this study was to assess the prevalence of lung disorders and the diversity of the patient population. Methods: Retrospectively, all records (n=2352) of patients of the Department of Respiratory Diseases of the Dr. Horatio E. Oduber Hospital, Aruba, who were seen at the clinic at least once in the period between January 2010 and October 2014 were reviewed. Results: Asthma (22%) and sleeping disorders (20%) were the most prevalent diagnoses. The mean body mass index (BMI) of the overall lung patient population was 31.6 kg/m2. Obstructive sleep apnea syndrome (OSAS) was the most frequently diagnosed sleeping disorder (78.4%). A diagnosis of interstitial lung diseases (ILD) was established in 4.4% of the cases. Among the ILDs, non-specific interstitial pneumonia (NSIP: 28%), sarcoidosis (18%) and idiopathic pulmonary fibrosis (IPF: 16%) were the most frequent. Conclusion: Obesity and OSAS appeared to be major problems on Aruba. Increased awareness, education, and diagnostic facilities are required to prevent and diagnose obesity and OSAS in an early stage. NSIP, sarcoidosis and IPF are the most frequently diagnosed ILDs on Aruba, and optimization of ILD management is warranted, considering new treatment options available for ILD, especially for IPF.(Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 217-225)
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Affiliation(s)
- Deenstra Duco
- ild care foundation research team, The Netherlands.,Dept. of Pulmonology, Catharina Hospital, Eindhoven, The Netherland
| | | | - Kock Selene
- Dept. of Respiratory Medicine, Dr. Horacio E. Oduber Hospitaal, Oranjestad, Aruba
| | - Wills Stuart
- Dept. of Respiratory Medicine, Dr. Horacio E. Oduber Hospitaal, Oranjestad, Aruba
| | - Cobben Nicolle
- Dept. of Respiratory Medicine, Maastricht University Medical Centre (MUMC)
| | - Wijnen Petal
- ild care foundation research team, The Netherlands.,Dept. of Clinical Chemistry, Central Diagnostic Laboratory, MUMC
| | - Drent Marjolein
- ild care foundation research team, The Netherlands.,ILD Center of Excellence, St. Antonius Hospital Nieuwegein.,Dept. of Pharmacology and Toxicology, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
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Garbarino S, Bardwell WA, Guglielmi O, Chiorri C, Bonanni E, Magnavita N. Association of Anxiety and Depression in Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis. Behav Sleep Med 2020; 18:35-57. [PMID: 30453780 DOI: 10.1080/15402002.2018.1545649] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Obstructive sleep apnea (OSA) has been associated with mental disorders, but the strength of this association is unknown. The aim of our study was to investigate the association among OSA, depression, and anxiety in adults and to quantitatively summarize the results. Methods: A literature search in Medline, PubMed, PsycInfo, Scopus, and Web of Science was conducted. Seventy-three articles were selected for study. Results: The pooled prevalence of depressive and anxious symptoms in OSA patients was 35% (95% CI, 28-41%) and 32% (95% CI, 22-42%), respectively. Conclusions: The association between OSA, anxiety, and depression indicates the value of an early diagnosis and personalized treatment of OSA to improve mental disorders conditioning compliance to therapy. These conditions share a probably bidirectional relationship.
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Affiliation(s)
- Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Wayne A Bardwell
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Ottavia Guglielmi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Carlo Chiorri
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Enrica Bonanni
- Center of Sleep Medicine, Neurology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Nicola Magnavita
- Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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Owens H. Sleep-an Essential Component of Obesity Screening and Counseling: A Policy Analysis of the Affordable Care Act. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019842001. [PMID: 31014152 PMCID: PMC6482644 DOI: 10.1177/0046958019842001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The Patient Protection and Affordable Care Act (PPACA) has provided access to health care for millions of people in the United States. One of the most beneficial aspects of the PPACA is the obesity screening and counseling provision. Currently, it is estimated that over 39% of US adults are obese. Research has linked sleep disturbances to obesity and obesity-related behaviors. The purpose of this article is to advocate for evidence-based care through the inclusion of sleep disturbance screening and management under the PPACA obesity screening and counseling provision. An in-depth policy analysis of the PPACA was conducted to examine the feasibility of adding sleep screenings to the obesity screening and counseling provision available under current law. Findings suggest that the adoption of this policy would require stakeholder advocacy and educational reform. Implementation of the policy would require additional economic investments, but the long-term savings could be significant. A campaign to raise awareness regarding the association between sleep disturbance and obesity among the public and health care professionals would be essential. Policy implementation would require interprofessional collaboration when performing sleep disordered screening and management. Preventative health care for individuals who have not previously accessed the health care system has the potential to socially and economically benefit society if policies provide for evidence-based care. Sleep screening and counseling is essential under the PPACA to adequately address the US obesity crisis.
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Rhoades SD, Bastarache L, Denny JC, Hughey JJ. Pulling the covers in electronic health records for an association study with self-reported sleep behaviors. Chronobiol Int 2018; 35:1702-1712. [PMID: 30183400 DOI: 10.1080/07420528.2018.1508152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The electronic health record (EHR) contains rich histories of clinical care, but has not traditionally been mined for information related to sleep habits. Here, we performed a retrospective EHR study based on a cohort of 3,652 individuals with self-reported sleep behaviors documented from visits to the sleep clinic. These individuals were obese (mean body mass index 33.6 kg/m2) and had a high prevalence of sleep apnea (60.5%), however we found sleep behaviors largely concordant with prior prospective cohort studies. In our cohort, average wake time was 1 hour later and average sleep duration was 40 minutes longer on weekends than on weekdays (p < 10-12). Sleep duration varied considerably as a function of age and tended to be longer in females and in whites. Additionally, through phenome-wide association analyses, we found an association of long weekend sleep with depression, and an unexpectedly large number of associations of long weekday sleep with mental health and neurological disorders (q < 0.05). We then sought to replicate previously published genetic associations with morning/evening preference on a subset of our cohort with extant genotyping data (n = 555). While those findings did not replicate in our cohort, a polymorphism (rs3754214) in high linkage disequilibrium with a previously published polymorphism near TARS2 was associated with long sleep duration (p < 0.01). Collectively, our results highlight the potential of the EHR for uncovering the correlates of human sleep in real-world populations.
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Affiliation(s)
- Seth D Rhoades
- a Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Lisa Bastarache
- a Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Joshua C Denny
- a Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , Tennessee , USA.,b Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Jacob J Hughey
- a Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , Tennessee , USA.,c Department of Biological Sciences , Vanderbilt University , Nashville , Tennessee , USA
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Ceïde ME, Williams NJ, Seixas A, Longman-Mills SK, Jean-Louis G. Obstructive sleep apnea risk and psychological health among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) cohort study. Ann Med 2015; 47:687-93. [PMID: 26593384 PMCID: PMC4805365 DOI: 10.3109/07853890.2015.1107186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION This study assessed associations of depression and anxiety with risk of obstructive sleep apnea (OSA) among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) study. METHOD A total of 1,035 patients participated. ARES™ score ≥6 defined high OSA risk. Moderate depression was defined by a CES-D score ≥16. Moderate anxiety was measured by a BAI score ≥16. RESULTS The mean age was 62 ± 14 years; 70% were female. A total of 93% were diagnosed with hypertension; 61%, diabetes; and 72%, dyslipidemia; 90% were overweight/obese; 33% had a history of heart disease; and 10% had a stroke. Logistic regression analysis, adjusting for age and gender, showed that patients with depression had nearly two-fold increased odds of being at risk for OSA (OR 1.75, 95% CI 1.02-2.98, p < 0.05). Patients with anxiety had three-fold increased odds of being at risk for OSA (OR 3.30, 95% CI 2.11-5.15, p < 0.01). After adjusting for marital status and income, patients with anxiety had a 6% increase in OSA risk (OR 1.06, 95% CI 1.04-1.09, p < 0.05), but depression was no longer significant. CONCLUSION Our results suggest that non-Hispanic blacks with metabolic syndrome who experience anxiety and/or depression should be screened for OSA.
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Affiliation(s)
- Mirnova E Ceïde
- a Montefiore Medical Center , Department of Psychiatry and Behavioral Science , Bronx , NY 10467 , USA
| | - Natasha J Williams
- b Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health , New York University Medical Center , New York , NY 10016 , USA
| | - Azizi Seixas
- b Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health , New York University Medical Center , New York , NY 10016 , USA
| | - Samantha K Longman-Mills
- c Department of Community Health and Psychiatry , The University of the West Indies , Mona , Jamaica
| | - Girardin Jean-Louis
- b Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health , New York University Medical Center , New York , NY 10016 , USA
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Wang Y, Geater AF, Chai Y, Luo J, Niu X, Hai B, Qin J, Li Y. Pre- and in-therapy predictive score models of adult OSAS patients with poor adherence pattern on nCPAP therapy. Patient Prefer Adherence 2015; 9:715-23. [PMID: 26064041 PMCID: PMC4455858 DOI: 10.2147/ppa.s83105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To identify patterns of adherence to nasal continuous positive airway pressure (nCPAP) use in the first 3 months of therapy among newly diagnosed adult patients with obstructive sleep apnea/hypopnea syndrome (OSAS) and their predictors. To develop pretherapy and in-therapy scores to predict adherence pattern. METHODS Newly diagnosed adult OSAS patients were consecutively recruited from March to August 2013. Baseline clinical information and measures such as Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Zung's Self-Rating Depression Scale (SDS), and The Pittsburgh Sleep Quality Index (PSQI) at baseline and at the end of 3rd-week therapy were collected. Twelve weeks' adherence data were collected from the nCPAP memory card, and K-means cluster analysis was used to explore adherence patterns. Predictive scores were developed from the coefficients of cumulative logit models of adherence patterns using variables available at baseline and after 3 weeks of therapy. Performance of the score was validated using 500 bootstrap resamples. RESULTS Seventy six patients completed a 12-week follow-up. Three patterns were revealed. Patients were identified as developing an adherence pattern that was poor (n=14, mean ± SD, 2.3±0.9 hours per night), moderate (n=19, 5.3±0.6 hours per night), or good (n=43, 6.8±0.3 hours per night). Cumulative logit regression models (good → moderate → poor) revealed independent baseline predictors to be ESS (per unit increase) (OR [95% CI], 0.763 [0.651, 0.893]), SDS (1.461 [1.238, 1.724]), and PSQI (2.261 [1.427, 3.584]); and 3-week therapy predictors to be ESS (0.554 [0.331, 0.926]), PSQI (2.548 [1.454, 4.465]), and the changes (3rd week-baseline data) in ESS (0.459 [0.243, 0.868]), FSS (3.556 [1.788, 7.070]), and PSQI (2.937 [1.273, 6.773]). Two predictive score formulas for poor adherence were developed. The area under the curve (AUC) of the receiver operating characteristics (ROC) curves for baseline and 3-week formulas were 0.989 and 0.999, respectively. Bootstrap analysis indicated positive predictive values of baseline and 3-week predictive scores in our patient population of 0.82 (95% CI [0.82, 0.83]) and 0.94 (95% CI [0.93, 0.94]), respectively. CONCLUSION A high level of prediction of poor adherence pattern is possible both before and at the first 3 weeks of therapy. The predictive scores should be further evaluated for external validity.
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Affiliation(s)
- Yeying Wang
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Alan F Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Yanling Chai
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Jiahong Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Xiaoqun Niu
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Bing Hai
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Jingting Qin
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
| | - Yongxia Li
- Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
- Correspondence: Yongxia Li, Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, No 374, Dianmian Road, Kunming 650101, Yunnan Province, People’s Republic of China, Tel +86 136 5881 0805, Fax +86 871 6535 2087, Email
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