The Association of Sleep Apnea and Cancer in Veterans

Abstract

Objective To test the association between preexisting obstructive sleep apnea (OSA) and subsequent cancer in a large long-term cohort of veteran patients. Study Design Retrospective matched cohort study. Setting The Veterans Affairs Health Care System. Subjects and Methods All veteran patients diagnosed with OSA between 1993 and 2013 by International Classification of Diseases, Ninth Revision ( ICD-9) codes in any Veterans Affairs facility and veteran patients without an OSA diagnosis, matched to patients with OSA by age and index year. Cancer diagnoses were identified by ICD-9 codes for the time period at least 2 years after OSA diagnosis or index date. We tested the association between OSA and cancer using multivariate Cox regression with time since cohort entry as the time axis, adjusting for potential confounders. Results The cohort included 1,377,285 patients (726,008 with and 651,277 without an OSA diagnosis) with mean age of 55 years, predominantly male (94%), a minority obese (32%), and median follow-up of 7.4 years (range, 2.0-25.2). The proportion of patients diagnosed with cancer was higher in those with vs without an OSA diagnosis (8.3% vs 3.6%; mean difference 4.8%; 95% confidence interval [CI], 4.7%-4.8%; P < .001). After adjusting for age, sex, year of cohort entry, smoking status, alcohol use, obesity, and comorbidity, the hazard of incident cancer was nearly double in patients with vs without an OSA diagnosis (hazard ratio, 1.97; 95% CI, 1.94-2.00; P < .001). Conclusion Preexisting OSA was strongly associated with subsequent cancer in this veteran cohort, independent of several known cancer risk factors. These findings suggest that OSA may be a strong, independent risk factor for subsequent cancer development.

Eight‐Year Follow‐up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

“…69,70 There is also evidence for a more than threefold increase in traffic accidents. 71 In addition, studies have reported increased risk of cancer, 18,72,73 metabolic disorders, 74,75 and all-cause mortality. 17 The physiological pathways between OSA and its negative consequences are complex and not fully understood.…”

The Association between Obstructive Sleep Apnea and Post Traumatic Stress Disorder

“…Additionally, the co-occurrence of OSA and PTSD is more likely associated with increased PTSD symptoms severity [13]. Left untreated, OSA can lead to the development of serious chronic medical conditions such as type 2 diabetes, cardiovascular disease, stroke, hypertension heart failure, dementia, and certain type of cancers [7,14,15], thus further aggravating preexisting PTSD. Untreated OSA can also lead to neurocognitive deficits and the development of other psychiatric disorders and substance abuse which can lead to worsening severity of PTSD symptoms [16,17].…”

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

“…Overall, eight cohort studies with 1 398 113 women were included in this meta-analysis. [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.…”

“…[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.…”