Background and Purpose—: The studies assessing the impact of insomnia on stroke are still lacking. We aim to investigate insomnia in relation to subsequent stroke during the 4-year follow-up. Methods—: Data from the Taiwan National Health Insurance Research Database were used. Enrollees with International Classification of Diseases, Ninth Revision , Clinical Modification diagnosis code for insomnia were compared with randomly selected, age- and sex-matched noninsomnia enrollees with subsequent hospitalization for stroke during the 4-year follow-up. All enrollees, insomniacs and noninsomniacs, did not have previous diagnosis of stroke, sleep apnea, and insomnia. Individuals with insomnia were further categorized into different subgroups based on their insomnia patterns to explore whether the risk of stroke varies by subtype. The risk of outcomes was assessed with Kaplan–Meier curves and the impact of insomnia was estimated using Poisson regression analysis and Cox proportional hazards models. Results—: The study included 21 438 (mean age, 52±16 years) insomniacs and 64 314 matched noninsomniacs (mean age, 51±16 years). Compared with noninsomniacs, insomniacs had 54% higher risk of developing stroke (adjusted hazard ratio, 1.54; 95% confidence interval, 1.38–1.72). When breaking down into insomnia subgroups, the persistent insomniacs had a higher 3-year cumulative incidence rate of stroke than those in the remission group ( P =0.024). The insomniacs-to-noninsomniacs incidence rate ratio for stroke was highest among those aged 18 to 34 years (incidence rate ratio, 8.06). Conclusions—: Insomnia predisposes individuals to increased risk of stroke and this association is profound among young adults. Our results underscore the clinical importance of identifying and treating insomnia. A novel behavioral intervention targeting insomnia that may prevent stroke should be explored.

Using Taiwan’s in-patient claims database, the effect of anesthetic technique on in-hospital outcomes was assessed. Neuraxial techniques were found to have lower rates of in-hospital adverse outcomes of several types including mortality, stroke, and others. Background: The effects of the mode of anesthesia on major adverse postoperative outcomes in geriatric patients are still inconclusive. The authors hypothesized that a neuraxial anesthetic (NA) rather than a general anesthetic (GA) would yield better in-hospital postoperative outcomes for geriatric patients undergoing hip surgery. Methods: The authors used data from Taiwan’s 1997–2011 in-patient claims database to evaluate the effect of anesthesia on in-hospital outcomes. The endpoints were mortality, stroke, transient ischemic stroke, myocardial infarction, respiratory failure, and renal failure. Of the 182,307 geriatric patients who had hip surgery, a GA was given to 53,425 (29.30%) and an NA to 128,882 (70.70%). To adjust for baseline differences and selection bias, patients were matched on propensity scores, which left 52,044 GA and 52,044 NA patients. Results: GA-group patients had a greater percentage and higher odds of adverse in-hospital outcomes than did NA-group patients: death (2.62 vs. 2.13%; odds ratio [OR], 1.24; 95% CI, 1.15 to 1.35; P < 0.001), stroke (1.61 vs. 1.38%; OR, 1.18, 95% CI, 1.07 to 1.31; P = 0.001), respiratory failure (1.67 vs. 0.63%; OR, 2.71; 95% CI, 2.38 to 3.01; P < 0.001), and intensive care unit admission (11.03 vs. 6.16%; OR, 1.95; 95% CI, 1.87 to 2.05; P < 0.001), analyzed using conditional logistic regression. Moreover, patients given a GA had longer hospital stays (10.77 ± 8.23 vs. 10.44 ± 6.67 days; 95% CI, 0.22 to 0.40; P < 0.001) and higher costs (New Taiwan Dollars [NT$] 86,606 ± NT$74,162 vs. NT$74,494 ± NT$45,264; 95% CI, 11,366 to 12,859; P < 0.001). Conclusion: For geriatric patients undergoing hip surgery, NA was associated with fewer odds of adverse outcomes than GA.

Objectives To explore the risk of development of sudden sensorineural hearing loss (SSHL) among diabetes mellitus patients. Study Design A retrospective cohort study. Setting Population-based study of Taiwan National Health Insurance Research Database. Patients Approximately 26,556 newly diagnosed diabetic patients and 26,556 comparison subjects without diabetes mellitus were selected from claims made during 2000 to 2004. Main Outcome Measures The incidence of sudden sensorineural hearing loss (SSHL) at the end of 2009 was determined. Results The incidence of SSHL was 1.54-fold higher in the diabetic group compared with the nondiabetic group (1.29 versus 0.78 per 1,000 person-years), and using Cox proportional hazard regressions, the adjusted hazard ratio (HR) was 1.592 (95% confidence interval [CI], 1.295–1.957). The risk of developing SSHL increased substantially to an HR of 2.060 (95% CI, 1.051–4.037), for patients who required triple antidiabetic medication compared with diabetic patients treated with a single antidiabetic drug. An increased risk of developing SSHL, with adjusted HRs of 1.574 (95% CI, 1.091–2.271) and 2.842 (95% CI, 1.880–4.295), was observed in diabetic patients with newly diagnosed comorbidities of retinopathy or retinopathy combined with renal insufficiency, which are both expected to reflect the severity of diabetes. Conclusion Diabetes mellitus was significantly associated with an increased risk of developing SSHL. Coronary heart disease or retinopathy comorbidities in diabetic patients seemed to be associated with an increased risk of developing SSHL. The risk of developing SSHL increased with the severity of diabetes.