{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:34:37Z","timestamp":1760240077489,"version":"build-2065373602"},"reference-count":27,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2019,2,5]],"date-time":"2019-02-05T00:00:00Z","timestamp":1549324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","award":["KMUH106-6R12","KMUH106-6T05","KMUH107-7M07"],"award-info":[{"award-number":["KMUH106-6R12","KMUH106-6T05","KMUH107-7M07"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004694","name":"Kaohsiung Medical University","doi-asserted-by":"publisher","award":["KMU-Q108005"],"award-info":[{"award-number":["KMU-Q108005"]}],"id":[{"id":"10.13039\/501100004694","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The association between sleep apnea (SA) and peripheral artery disease (PAD) remains debatable, and there is no clinical tool to predict incident PAD in SA patients. The CHADS2 score has been found useful in predicting PAD risk. This study was designed to investigate the association between these diseases and the usefulness of CHADS2 and CHA2DS2ASc scores in predicting subsequent PAD in SA patients. From a population-based database of one-million representative subjects, adult patients with SA diagnosis were enrolled as the suspected SA group, and those having SA diagnosis after polysomnography were further extracted as the probable SA group. Twenty sex- and age-matched control subjects were randomly selected for each SA patients. The occurrence of PAD after SA was taken as the primary endpoint. Totally, 10,702 and 4242 patients were enrolled in the suspected and probable SA groups, respectively. The cumulative incidence of PAD was similar between SA patients and the corresponding control groups. Multivariable Cox regression analyses showed that SA was not an independent risk factor for subsequent PAD. Sensitivity analyses using propensity score-matched cohorts showed consistent results. Furthermore, in stratifying the SA patients by CHADS2, CHA2DS2ASc, or a newly-proposed ABCD (composed of Age, high Blood pressure, Cerebral vascular disease, and Diabetes mellitus) score, patients with higher scores predicted higher risks of subsequent PAD, while the ABCD score appeared to be the most robust. Aggressive risk modification is suggested to reduce the subsequent PAD risk in SA patients with a higher CHADS2, CHA2DS2ASc, or ABCD score.<\/jats:p>","DOI":"10.3390\/jcm8020188","type":"journal-article","created":{"date-parts":[[2019,2,6]],"date-time":"2019-02-06T03:03:05Z","timestamp":1549422185000},"page":"188","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["CHADS2, CHA2DS2ASc, and New ABCD Scores Predict the Risk of Peripheral Arterial Disease in Patients with Sleep Apnea"],"prefix":"10.3390","volume":"8","author":[{"given":"Kuan-Li","family":"Wu","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia-Yu","family":"Kuo","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Chen","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jen-Yu","family":"Hung","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7979-3749","authenticated-orcid":false,"given":"Chau-Chyun","family":"Sheu","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Jen","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chung-Yao","family":"Hsu","sequence":"additional","affiliation":[{"name":"Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meng-Ni","family":"Wu","sequence":"additional","affiliation":[{"name":"Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3621-3334","authenticated-orcid":false,"given":"Ming-Ju","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,2,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.5665\/sleep.5962","article-title":"Prevalence and characteristics of central compared to obstructive sleep apnea: Analyses from the sleep heart health study cohort","volume":"39","author":"Donovan","year":"2016","journal-title":"Sleep"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1001\/jama.2016.19635","article-title":"Screening for obstructive sleep apnea in adults: Evidence report and systematic review for the us preventive services task force","volume":"317","author":"Jonas","year":"2017","journal-title":"JAMA"},{"key":"ref_3","first-page":"196","article-title":"Cardiovascular consequences of obstructive sleep apnoea","volume":"131","author":"Kuniyoshi","year":"2010","journal-title":"Indian J. Med. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1161\/CIRCULATIONAHA.110.003954","article-title":"Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to 2004","volume":"124","author":"Pande","year":"2011","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/S2213-8587(17)30183-3","article-title":"Measures of chronic kidney disease and risk of incident peripheral artery disease: A collaborative meta-analysis of individual participant data","volume":"5","author":"Matsushita","year":"2017","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1161\/CIRCRESAHA.116.303849","article-title":"Epidemiology of peripheral artery disease","volume":"116","author":"Criqui","year":"2015","journal-title":"Circ. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s00392-015-0834-3","article-title":"High prevalence of peripheral arterial disease in patients with obstructive sleep apnoea","volume":"104","author":"Schaefer","year":"2015","journal-title":"Clin. Res. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1111\/coa.12393","article-title":"Risks of peripheral arterial occlusive disease in patients with obstructive sleep apnoea: A population-based case-control study","volume":"40","author":"Chen","year":"2015","journal-title":"Clin. Otolaryngol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2864","DOI":"10.1001\/jama.285.22.2864","article-title":"Validation of clinical classification schemes for predicting stroke: Results from the National Registry of Atrial Fibrillation","volume":"285","author":"Gage","year":"2001","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"490","DOI":"10.5551\/jat.27284","article-title":"CHADS2 score and risk of new-onset peripheral arterial occlusive disease in patients without atrial fibrillation: A nationwide cohort study in Taiwan","volume":"22","author":"Hsu","year":"2015","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"322","DOI":"10.5551\/jat.21212","article-title":"Association between the CHADS2 score and an ankle-brachial index of 0.9 in patients without atrial fibrillation","volume":"21","author":"Hsu","year":"2014","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.lungcan.2014.09.012","article-title":"Metformin decreases lung cancer risk in diabetic patients in a dose-dependent manner","volume":"86","author":"Tsai","year":"2014","journal-title":"Lung Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Chen, C.M., Tsai, M.J., Wei, P.J., Su, Y.C., Yang, C.J., Wu, M.N., Hsu, C.Y., Hwang, S.J., Chong, I.W., and Huang, M.S. (2015). Erectile dysfunction in patients with sleep apnea\u2014A nationwide population-based study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0132510"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"23979","DOI":"10.1038\/srep23979","article-title":"Cysteinyl leukotriene receptor antagonists decrease cancer risk in asthma patients","volume":"6","author":"Tsai","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.amjmed.2012.08.017","article-title":"Sleep apnea and risk of peptic ulcer bleeding: A nationwide population-based study","volume":"126","author":"Shiao","year":"2013","journal-title":"Am. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Chou, P.S., Chang, W.C., Chou, W.P., Liu, M.E., Lai, C.L., Liu, C.K., Ku, Y.C., Tsai, S.J., Chou, Y.H., and Chang, W.P. (2014). Increased risk of benign prostate hyperplasia in sleep apnea patients: A nationwide population-based study. PLoS One, 9.","DOI":"10.1371\/journal.pone.0093081"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1503\/cmaj.131547","article-title":"Sleep apnea and risk of pneumonia: A nationwide population-based study","volume":"186","author":"Su","year":"2014","journal-title":"CMAJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"213","DOI":"10.5665\/sleep.4400","article-title":"Sleep apnea and the risk of chronic kidney disease: A nationwide population-based cohort study","volume":"38","author":"Lee","year":"2015","journal-title":"Sleep"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1370\/afm.1815","article-title":"Sleep apnea and risk of panic disorder","volume":"13","author":"Su","year":"2015","journal-title":"Ann. Fam. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Lin, C.S., Chen, S.J., Sung, C.C., Lin, C.L., Lin, S.H., Cheng, S.M., Wang, I.K., Huang, W.S., and Kao, C.H. (2015). Hemodialysis is associated with increased peripheral artery occlusive disease risk among patients with end-stage renal disease: A nationwide population-based cohort study. Medicine, 94.","DOI":"10.1097\/MD.0000000000001164"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1160\/th15-07-0600","article-title":"Risk of peripheral arterial occlusive disease in patients with rheumatoid arthritis. A nationwide population-based cohort study","volume":"115","author":"Chuang","year":"2016","journal-title":"Thromb. Haemost."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/0895-4356(92)90133-8","article-title":"Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases","volume":"45","author":"Deyo","year":"1992","journal-title":"J. Clin. Epidemiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Pizarro, C., Schaefer, C., Kimeu, I., Pingel, S., Horlbeck, F., Tuleta, I., Nickenig, G., and Skowasch, D. (2015). Underdiagnosis of obstructive sleep apnoea in peripheral arterial disease. Respiration.","DOI":"10.1055\/s-0035-1544756"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Schahab, N., Sudan, S., Schaefer, C., Tiyerili, V., Steinmetz, M., Nickenig, G., Skowasch, D., and Pizarro, C. (2017). Sleep apnoea is common in severe peripheral arterial disease. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0181733"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.atherosclerosis.2016.06.040","article-title":"Association of sleep apnea and sleep duration with peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis (MESA)","volume":"251","author":"Nagayoshi","year":"2016","journal-title":"Atherosclerosis"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1161\/CIRCULATIONAHA.107.189420","article-title":"Sleep apnea and cardiovascular disease: An American Heart Association\/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health)","volume":"118","author":"Somers","year":"2008","journal-title":"Circulation"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1038\/s41598-018-19243-y","article-title":"Association between modified CHA2DS2-VASc Score with Ankle-Brachial index <0.9","volume":"8","author":"Hsu","year":"2018","journal-title":"Sci. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/2\/188\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:31:06Z","timestamp":1760185866000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/2\/188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,5]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,2]]}},"alternative-id":["jcm8020188"],"URL":"https:\/\/doi.org\/10.3390\/jcm8020188","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2019,2,5]]}}}