Association Between Nocturnal Hypoxemia and Cancer Incidence in Patients Investigated for OSA

Justeau, G.; Gervès-Pinquié, Chloé; Vaillant, Marc Le; Trzépizur, Wojciech; Meslier, Nicole; Goupil, F.; Pigeanne, Thierry; Launois, Sandrine; Leclair‐Visonneau, Laurène; Masson, Philippe; Bizieux-Thaminy, Acya; Humeau, Marie-Pierre; Gosselin, Christelle; Blanchard, Margaux; Urban, T.; Gagnadoux, Frédéric; Person, Christine; Priou, Pascaline; Molinier, Olivier; Paris, Audrey; Caby, Isabelle; Bellier, Maël; Langelot-Richard, Marie; Jaffré, S.; Corne, F.; Tranchade, Marc Normand de la; Rouault, Béatrice

doi:10.1016/j.chest.2020.06.055

Cited by 55 publications

(66 citation statements)

References 33 publications

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“…OSA is also being documented as an independent risk factor for stroke, hypertension, coronary heart disease, and abnormal glucose metabolism [29][30][31][32]. Even more, in the last 10 years, experimental studies have advised that OSA might supply the tumour growth and metastatisation [33]; in fact, numerous mechanisms may connect OSA with cancer incidence and prognosis such as systemic inflammation, sympathetic over-activity, angiogenesis, and immunological alterations [33]. A recent study has linked severe OSA with an amplified risk of cancer mortality in patients with stage III-IV lung cancer [34], while another research has identified the disease as a risk factor for breast cancer in women [35].…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnoea in Patients Treated for Head and Neck Cancer: A Systematic Review of the Literature

et al. 2020

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Background and objectives: Obstructive sleep apnoea (OSA) is clinically defined by signs of daytime sleepiness and objective measures of disordered breathing during sleep. The literature is still controversial on the incidence and aetiology of OSA secondary to head and neck cancer treatment. The aim of this systematic review is to evaluate and discuss the prevalence of OSA in patients treated with surgery and/or chemo/radiotherapy for head and neck cancer. Materials and methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was performed on May 2020 using the MEDLINE database, Scopus, and Google Scholar. The searches were conducted using combinations of the following terms: head and neck cancer, OSA, radiotherapy, chemotherapy, partial laryngectomy, laryngeal cancer, neoplasm, tumour, carcinoma, and oropharyngeal cancer. Results: Our results suggest that head and neck cancer patients have a higher incidence of OSA (59.78%) compared to the general population; differences may occur based on the type of treatment. Conclusions: Clinicians should recognise the higher prevalence of OSA in patients treated for head and neck cancer and should consider a comprehensive sleep history as part of the evaluation and management of these patients. Further research is needed to evaluate the exact prevalence, aetiology, and correct management of OSA after treatment for head and neck cancer.

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Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnoea in Patients Treated for Head and Neck Cancer: A Systematic Review of the Literature

et al. 2020

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“…The lowest was only 3.5% from an insurance database ( 15 ), whereas the highest was 31.5% in a community-based resident study with 20-year follow-up ( 22 ). Cancer incidence ranged from 5.1% to 6.5% in three retrospective studies from hospitals ( 13 , 14 , 16 ), while a prospective cohort study reported an incidence rate of 8.2% ( 26 ). A recent meta-analysis showed that OSA is associated with an increased overall cancer incidence ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

The Incidence of Cancer Is Increased in Hospitalized Adult Patients With Obstructive Sleep Apnea in China: A Retrospective Cohort Study

et al. 2022

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BackgroundThe association between obstructive sleep apnea (OSA) and the incidence and mortality of cancer remain unclear, especially in Asian populations. Thus, this study was conducted to explore the relationship between OSA and the incidence and mortality of cancer in hospitalized patients.MethodsThis retrospective cohort study evaluated inpatients from Guangdong Provincial People’s Hospital for suspected OSA between January 2005 and December 2015. Cancer incidence, all-cause mortality, and cancer mortality and were determined using data from the hospital information system and Centers for Disease Control. Between-group comparisons were carried out by performing a chi-square test and analysis of variance. Kaplan–Meier analysis and the Cox proportional risk model were applied to investigate the association between OSA and cancer incidence and mortality.ResultsOf the 4,623 hospitalized patients included, 3,786 (81.9%) patients were diagnosed with OSA. After a median follow-up of 9.1 years (interquartile range, 9.79–11.44), the incidence of cancer was 6.6% (251/3,786), with lung cancer having the highest incidence at 1.6% (60/3,786). The mortality rate of OSA patients was higher than that of non-OSA patients (16.83% vs.12.78%, p=0.008), but the relationship between apnea-hypopnea index (AHI), oxygen saturation less than 90% (TSat90), and cancer mortality was not statistically significant (p>0.05).The mortality rate for all types of cancer was 2.8% (105/3,786), with lung cancer having the highest mortality rate at 0.8% (32/3,786). The cumulative incidence of cancer in the severe OSA group was 8.2%, which was higher than that in the normal, mild, and moderate OSA groups (P=0.010). Further, the Cox proportional risk regression model showed a progressive enhancement in the risk of cancer incidence as the AHI increased (adjusted hazard ratio [HR]: 1.009 [95% confidence interval (CI): 1.003–1.016], P=0.005). Based on subgroup analysis, the risk of cancer increased as the AHI increased in patients aged <65 years (adjusted HR: 1.019 [95% CI: 1.007–1.031], P=0.002). In addition, the cancer incidence was significantly higher in the severe OSA group than in the normal, mild, and moderate OSA groups (adjusted HR: 2.825 [95% CI: 1.358–5.878], P=0.019).ConclusionThe incidence of cancer is higher in patients with OSA than in non-OSA patients and is significantly positively associated with the severity of OSA. Particularly, for OSA patients aged <65 years, lung cancer is the main cause of death in those with new-onset cancer. Mortality was higher in OSA patients than in non-OSA patients.

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“…Nieto and colleagues were among the first to demonstrate that OSA was associated with total and cancer mortality in a dose-response fashion in a community-based sample [13]. Furthermore, a large multicenter cohort study by Justeau and colleagues found that nocturnal hypoxemia predicted all-cancer incidence in patients investigated for suspected OSA, independently of major confounding factors [39]. Older people with obesity and no adequate OSA therapy were most often affected, and the most common types of cancer were lung and breast [39].…”

Section: Obstructive Sleep Apnea and Cancer Riskmentioning

confidence: 99%

“…Furthermore, a large multicenter cohort study by Justeau and colleagues found that nocturnal hypoxemia predicted all-cancer incidence in patients investigated for suspected OSA, independently of major confounding factors [39]. Older people with obesity and no adequate OSA therapy were most often affected, and the most common types of cancer were lung and breast [39]. Li and colleagues described OSA severity as a risk factor that contributed to short overall survival in patients with lung cancer [6].…”

Section: Obstructive Sleep Apnea and Cancer Riskmentioning

confidence: 99%

Obstructive Sleep Apnea in Patients with Head and Neck Cancer—More than Just a Comorbidity?

et al. 2021

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Obstructive sleep apnea is the most common type of sleep-disordered breathing with growing prevalence. Its presence has been associated with poor quality of life and serious comorbidities. There is increasing evidence for coexisting obstructive sleep apnea in patients suffering from head and neck cancer, a condition that ranks among the top ten most common types of cancer worldwide. Routinely, patients with head and neck cancer are treated with surgery, radiation therapy, chemotherapy, immunotherapy or a combination of these, all possibly interfering with the anatomy of the oral cavity, pharynx or larynx. Thus, cancer treatment might worsen already existing obstructive sleep apnea or trigger its occurrence. Hypoxia, the hallmark feature of obstructive sleep apnea, has an impact on cancer biology and its cure. Early diagnosis and sufficient treatment of coexisting obstructive sleep apnea in patients with head and neck cancer may improve quality of life and could also potentially improve oncological outcomes.

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Association Between Nocturnal Hypoxemia and Cancer Incidence in Patients Investigated for OSA

Cited by 55 publications

References 33 publications

Obstructive Sleep Apnoea in Patients Treated for Head and Neck Cancer: A Systematic Review of the Literature

Obstructive Sleep Apnoea in Patients Treated for Head and Neck Cancer: A Systematic Review of the Literature

The Incidence of Cancer Is Increased in Hospitalized Adult Patients With Obstructive Sleep Apnea in China: A Retrospective Cohort Study

Obstructive Sleep Apnea in Patients with Head and Neck Cancer—More than Just a Comorbidity?

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