Obstructive Sleep Apnea and Incident Cancer: A Large Retrospective Multicenter Clinical Cohort Study

Abstract

Background: To examine the association between the severity of obstructive sleep apnea (OSA) and nocturnal hypoxemia with incident cancer. Methods: This was a multicenter retrospective clinical cohort study using linked clinical and provincial health administrative data on consecutive adults who underwent a diagnostic sleep study between 1994 and 2017 in four academic hospitals (Canada) who were free of cancer at baseline. Cancer status was derived from the Ontario Cancer Registry. Cox cause–specific regressions were utilized to address the objective and to calculate the 10-year absolute risk difference (ARD) in the marginal probability of incident cancer and the number needed to harm (NNH). Results: Of 33,997 individuals considered, 33,711 with no missing OSA severity were included: median age, 50 years; 58% male; and 23% with severe OSA (apnea-hypopnea index >30). Of the 18,458 individuals with information on sleep time spent with oxygen saturation (SaO2) <90%, 5% spent >30% of sleep with SaO2 <90% (severe nocturnal hypoxemia). Over a median of 7 years, 2,498 of 33,711 (7%) individuals developed cancer, with an incidence rate of 10.3 (10.0–10.8) per 1,000 person-years. Controlling for confounders, severe OSA was associated with a 15% increased hazard of developing cancer compared with no OSA (HR = 1.15, 1.02–1.30; ARD = 1.28%, 0.20–2.37; and NNH = 78). Severe hypoxemia was associated with about 30% increased hazard (HR = 1.32, 1.08–1.61; ARD = 2.38%, 0.47–4.31; and NNH = 42). Conclusions: In a large cohort of individuals with suspected OSA free of cancer at baseline, the severity of OSA and nocturnal hypoxemia was independently associated with incident cancer. Impact: These findings suggest the need for more targeted cancer risk awareness in individuals with OSA.

Relationship Between CPAP Termination and All-Cause Mortality

“…Longer follow-up durations also have been used in studies evaluating the link between OSA and cancer. [32][33][34] The significant negative impact of terminating CPAP therapy in the first year highlights the importance of strategies to improve adherence to, and continuation with, CPAP. A personalized medicine approach using telemedicine-based support programs already has been shown to improve positive airway pressure use and to reduce the number of patients terminating therapy in real-world settings.…”

Sleep‐disordered breathing and risk of the breast cancer: A meta‐analysis of cohort studies

“…[17][18][19][20][21][22][23][24] Characteristics of the included studies were shown in Table 1. These studies were published from 2014 to 2021 and performed in the United States, 19,20,22,23 Canada, 24 China 17,18 and Korea. 21 Regarding study design, three of them were prospective cohort studies, 17,19,23 while the other five were retrospective studies.…”

“…The mean ages of the women varied from 48 to 74 years at baseline. The diagnosis of SDB was based on clinical evaluation involving polysomnography in three studies, 18,23,24 while based on codes of International Classification of Diseases (ICD) in five studies. The NOS varied from 7 to 9 for the included studies (Table 2), suggesting generally good quality of the included studies.…”

Prediction of Moderate to Severe Obstructive Sleep Apnea Using Neck Computed Tomography With Computational Fluid Dynamics Study

“…Obstructive sleep apnea (OSA) is a so-called invisible killer disorder characterized by repetitive pauses of airflow through the upper airway with hypoxia during sleep (1). Intermittent hypoxemia may lead to systemic inflammation, which may play a vital role for risk of cardiovascular disease (CVD), diabetes, and cancer (1)(2)(3)(4). A Swiss study observed that the prevalence of moderate to severe sleep apnea (apnea-hypopnea index [AHI] ≥ 15 episodes per hour) was 49.7% in men and 23.4% in women (5).…”

“…A Swiss study observed that the prevalence of moderate to severe sleep apnea (apnea-hypopnea index [AHI] ≥ 15 episodes per hour) was 49.7% in men and 23.4% in women (5). Evidence has indicated that approximately 1 billion adults worldwide aged between 30 and 60 years may have OSA, which carries risks of major morbidity and mortality (2)(3)(4)6). Patients with OSA may experience considerably worse health and quality of life (7).…”