{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:44:54Z","timestamp":1790095494102,"version":"4.0.1"},"reference-count":33,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T00:00:00Z","timestamp":1616112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST 109-2314-B-182A-054-"],"award-info":[{"award-number":["MOST 109-2314-B-182A-054-"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Chiayi Chang Gung Memorial Hospital :","award":["CMRPG6K0301 and CMRPG6J0331"],"award-info":[{"award-number":["CMRPG6K0301 and CMRPG6J0331"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: Sleep apnea may be a risk factor for deep neck infection (DNI). The objective of this study was to investigate the effects of sleep apnea on DNI. (2) Methods: In this first nationwide retrospective cohort study on the sleep apnea\u2013DNI correlation, we obtained data from the Longitudinal Health Insurance Database 2005, a subset of the Taiwan National Health Insurance Research Database. Patients who were newly diagnosed with sleep apnea between 1997 and 2012 were identified, and patients without sleep apnea were matched at a 1:4 ratio in age, sex, socioeconomic status, and urbanization level. The primary outcome of this study was DNI occurrence. The treatment modalities for sleep apnea and the comorbidities that occurred during the study period were also analyzed. (3) Results: Our sleep apnea and comparison (non-sleep apnea) cohorts comprised 6114 and 24,456 patients, respectively. We compared the cumulative incidence of DNI between these cohorts and found a greater incidence of DNI in the sleep apnea cohort (p &lt; 0.001). A strong sleep apnea\u2013DNI association was found following analysis via the adjusted Cox proportional-hazards model (full model hazard ratio, 1.71; 95% confidence interval, 1.28\u20132.28; p &lt; 0.001). In the subgroup analysis, sleep apnea increased DNI risk in men, in those aged &lt; 50 years, and in those without diabetes mellitus, end-stage renal disease, liver cirrhosis, autoimmune disease, obesity, tonsillectomy, or adenotonsillectomy. (4) Conclusions: Our results confirmed sleep apnea to be an independent risk factor for DNI. Physicians should be aware of the potential occurrence of DNI in patients with sleep apnea.<\/jats:p>","DOI":"10.3390\/ijerph18063191","type":"journal-article","created":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T11:18:38Z","timestamp":1616152718000},"page":"3191","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Deep Neck Infection Risk in Patients with Sleep Apnea: Real-World Evidence"],"prefix":"10.3390","volume":"18","author":[{"given":"Meng-Chang","family":"Ding","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3792-3784","authenticated-orcid":false,"given":"Cheng-Ming","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley Yung-Chuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Sleep Surgery, Department of Otolaryngology\u2013Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chan","family":"Lee","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8080-0504","authenticated-orcid":false,"given":"Yao-Hsu","family":"Yang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"},{"name":"Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Yen","family":"Liu","sequence":"additional","affiliation":[{"name":"Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5939-9747","authenticated-orcid":false,"given":"Geng-He","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao-Te","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8414-595X","authenticated-orcid":false,"given":"Li-Ang","family":"Lee","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Rung","family":"Yang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsueh-Yu","family":"Li","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9314-5940","authenticated-orcid":false,"given":"Ming-Shao","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1002\/lary.28272","article-title":"Real-world evidence for increased deep neck infection risk in patients with rheumatoid arthritis","volume":"130","author":"Chang","year":"2019","journal-title":"Laryngoscope"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4133","DOI":"10.1038\/s41598-020-61049-4","article-title":"Deep neck infection in Systemic Lupus erythematosus patients: Real-World evidence","volume":"10","author":"Chang","year":"2020","journal-title":"Sci. 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