Does OSA Increase Risk for Cancer?: A Large Historical Sleep Clinic Cohort Study

Non-linear association between weight-adjusted-waist index and obstructive sleep apnea: a cross-sectional study from the NHANES (2005-2008 to 2015-2020)

Background

The principal objective of the present investigation is to undertake an in-depth exploration of the relationship that exists between the newly introduced weight-adjusted waist index (WWI), employed as a surrogate way for corpulence, and obstructive sleep apnea (OSA).

Methods

Analysis using cross-sectional data from 11,545 NHANES participants across 2005-2008 and 2015-2020. Obesity via WWI (waist circumference over sqrt of body weight). OSA via 3 NHANES QnA items: monthly excessive sleepiness, weekly wheezing/snoring/breathing stoppage, weekly snoring. Relationships between WWI and OSA probed with weighted multivariate logistic regression and smoothed curve fitting. Also did subgroup, interaction tests and threshold effect analysis. Excluded those with incomplete WWI, OSA or hypertension data as they might have different health profiles. We excluded participants with incomplete data on WWI, OSA, or hypertation-related items, as those with missing data might have different health profiles.

Results

The study, encompassing a cohort of 11,545 participants, revealed that 5,727 individuals were diagnosed with OSA. Upon conducting fully adjusted models, A positive relevance between WWI and OSA was established, with an odds ratio of 1.57 (95% CI: 1.44, 1.71), indicating a significant relationship. Notably, participants falling within the highest quartile of WWI exhibited a markedly heightened propensity for OSA, being 2.58 times more likely to suffer from it than those in the bottom quartile [OR: 2.58 (95% CI: 2.10, 3.17)]. Rigorous subgroup analyses and interaction tests further confirmed the robustness of this positive association across various subgroups, thereby affirming the consistency of the observed relationship. Additionally, a noteworthy non-linear association and saturation phenomenon were discerned between the WWI and OSA, demarcated by an inflection point at 11.70 cm/√kg.

Conclusion

Our research has clearly shown a significant positive correlation, along with a saturation effect, between WWI and OSA in the American population. However, the cross-sectional design limits causal inference, and the exclusion of certain participants may affect the generalizability of the findings. Future longitudinal studies are needed to explore causality and address potential biases associated with participant exclusion, ultimately improving the broader applicability of the results.

Sleep and Cancer

Background/Objectives: Sleep issues are common in the general population, and these problems occur even more frequently for people with cancer. Sleep problems may pre-exist a patient's cancer diagnosis, and there is a growing interest in understanding the impact of sleep on cancer development and progression. Sleep disorders may impact cancer through altered metabolism, impacts on immune response, and alterations in hormones and gene expression. Sleep disorders may also arise after, or be aggravated by, an individual's cancer and cancer treatment. Treating a person with cancer's sleep disorder may help improve their healing, mental health, cognition, and overall resilience. Methods: Studies examining a variety of aspects of the relationship between sleep and cancer were found by searching the National Library of Medicine and characterized by their specific information provided on the relationship between sleep and cancer. Results: This review article summarizes our current understanding of the complex inter-relationship between sleep and cancer, the underlying mechanisms that create these connections, and the methods and impact of treating sleep issues in cancer patients. The article also outlines an approach to sleep complaints for clinicians caring for patients with cancer. Conclusions: Significant research is still needed to understand the full relationship between sleep disorders and cancer. The impact of sleep issues on cancer and of cancer on sleep appears to be specific to the tissue and the molecular type of cancer. The treatment of sleep disorders is multimodal, and offers a promising avenue to improve the health and quality of life of cancer patients.

The Association of Obstructive Sleep Apnea with Urological Cancer Incidence and Mortality-A Systematic Review and Meta-analysis

BACKGROUND AND OBJECTIVE

While obstructive sleep apnea (OSA) and urological cancer are both strongly associated with hypoxia, controversy exists regarding their association with each other. This study aims to summarize and synthesize evidence to clarify the association between OSA and urological cancer incidence and mortality.

METHODS

According to a prespecified protocol, PubMed, Embase, Cochrane Library, and Scopus were searched from inception to November 16, 2023, for observational and randomized studies reporting the association of OSA with urological cancer incidence or mortality. We pooled maximally covariate-adjusted hazard ratios (HRs) using a random-effects inverse variance-weighted model. Two reviewers independently assessed the quality of evidence using the Newcastle-Ottawa Scale and the Grading of Recommendations, Assessment, Development and Evaluation framework.

KEY FINDINGS AND LIMITATIONS

From 1814 records, we included 12 studies comprising 9 290 818 participants in total, of which nine studies were analyzed quantitatively. OSA patients had an increased risk of kidney (HR: 1.75, 95% confidence interval [CI]: 1.21-2.53) and bladder (HR: 1.76, 95% CI: 1.05-2.96) cancer. However, OSA was not associated with prostate cancer incidence (HR: 1.29, 95% CI: 0.82-2.04). We systematically reviewed evidence surrounding OSA and testicular cancer incidence and urological cancer mortality.

CONCLUSIONS AND CLINICAL IMPLICATIONS

OSA may be associated with a higher risk of kidney and bladder cancer, but not prostate cancer. Future work may help clarify the possibility of a dose-response relationship between OSA and urological cancer, and the effect of OSA treatment on urological cancer incidence or progression.

PATIENT SUMMARY

This research highlights a potential longitudinal association between OSA and kidney and bladder cancer, but not prostate cancer.

Association between obstructive sleep apnea and risk of lung cancer: findings from a collection of cohort studies and Mendelian randomization analysis

Background

Previous cohort studies conducted on large populations have suggested a potential association between obstructive sleep apnea (OSA) and an elevated risk of developing lung cancer. However, limited research has comprehensively investigated the correlation between the two conditions, and the causal effect remains unknown.

Methods

A comprehensive and systematic search was conducted across various databases, including PubMed, Web of Science, Cochrane Library, and Embase, from their inception dates to November 1, 2023. To assess the relationship between OSA and lung cancer, a meta-analysis was performed. Additionally, a two-sample Mendelian randomization (MR) study was conducted using summary data. The datasets included 336,659 individuals from the FinnGen study for OSA and 27,209 individuals from the International Lung Cancer Consortium study, as well as 420,473 individuals from the UK Biobank study for lung cancer. The estimates from each study were aggregated using the inverse variance-weighted method.

Results

Data from six population-based cohort studies, encompassing 6,589,725 individuals, indicated a significant increase in the risk of developing lung cancer among patients with OSA (HR 1.28, 95% CI 1.07-1.54). However, the MR analysis did not support a causal relationship between OSA and lung cancer (OR 1.001, 95% CI 0.929-1.100). This lack of association was consistent across specific subtypes of lung cancer, including non-small-cell lung cancer (OR 1.000, 95% CI 0.999-1.000, p = 0.974), lung adenocarcinoma (OR 0.996, 95% CI 0.906-1.094, p = 0.927), and squamous cell lung carcinoma (OR 1.034, 95% CI 0.937-1.140, p = 0.507).

Conclusions

Our meta-analysis findings suggest an elevated risk of lung cancer among individuals with OSA. However, the MR analysis did not provide evidence supporting a causal relationship between OSA and lung cancer. Further investigation is required to uncover the underlying factors contributing to the observed association between OSA and lung cancer risk.

Risk of cancer in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study

PURPOSE

This study aimed to obtain a comprehensive view of the risk of developing cancer in patients with obstructive sleep apnea (OSA) and to compare this risk between patients receiving continuous positive airway pressure (CPAP) therapy versus upper airway surgery (UAS).

METHODS

We used both local data and a global-scale federated data research network, TriNetX, to access electronic medical records, including those of patients diagnosed with OSA from health-care organizations (HCOs) worldwide. We used propensity score matching and the score-matched analyses of data for 5 years of follow-up, RESULTS: We found that patients who had undergone UAS had a similar risk of developing cancer than those who used CPAP [hazard ratio of 0.767 (95% CI 0.559-1.053; P = 0.100)].

CONCLUSION

Analysis of the large data sets collected from HCOs in Europe and globally lead us to conclude that in patients with OSA, neither CPAP nor UAS were associated with the development of cancer better than in non-treated patients.

Association of obstructive sleep apnea with risk of lung cancer: a nationwide cohort study in Korea

Current knowledge regarding the relationship between obstructive sleep apnea (OSA) and the risk of lung cancer is limited. This study aimed to evaluate associations between OSA and the incidence of lung cancer based on the Korean National Health Information Database. The study outcome was the incidence of newly diagnosed lung cancer, and a Cox proportional hazards model was used for analysis. A total of 181,070 adult patients newly diagnosed with OSA between 2011 and 2018 were matched with those without OSA by up to 1:5 propensity score matching based on age and sex. During follow-up over (mean ± standard deviation) 9.1 ± 2.0 years, 2614 incident cases of lung cancer were identified. The incidence rate was 39.51 per 100,000 person-years in the OSA group, and 24.93 per 100,000 person-years in the control group. After adjusting for income and the presence of comorbidities, the association remained significant (hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.74-2.18, p-value < 0.001). The adjusted HR for incident lung cancer was 2.14 (95% CI 1.69-2.70) in female patients with OSA, and 1.90 (95% CI 1.67-2.16) in male patients with OSA. The risk of incident lung cancer increased with age, with a HR of 2.99 (95% CI 2.46-3.64) in those aged ≥ 65 years. This nationwide study showed an independent association between OSA and an increased risk of lung cancer in the Korean population.

A review of obstructive sleep apnea and lung cancer: epidemiology, pathogenesis, and therapeutic options

Despite undeniable advances in modern medicine, lung cancer still has high morbidity and mortality rates. Lung cancer is preventable and treatable, and it is important to identify new risk factors for lung cancer, especially those that can be treated or reversed. Obstructive sleep apnea (OSA) is a very common sleep-breathing disorder that is grossly underestimated in clinical practice. It can cause, exacerbate, and worsen adverse outcomes, including death and various diseases, but its relationship with lung cancer is unclear. A possible causal relationship between OSA and the onset and progression of lung cancer has been established biologically. The pathophysiological processes associated with OSA, such as sleep fragmentation, intermittent hypoxia, and increased sympathetic nervous excitation, may affect normal neuroendocrine regulation, impair immune function (especially innate and cellular immunity), and ultimately contribute to the occurrence of lung cancer, accelerate progression, and induce treatment resistance. OSA may be a contributor to but a preventable cause of the progression of lung cancer. However, whether this effect exists independently of other risk factors is unclear. Therefore, by reviewing the literature on the epidemiology, pathogenesis, and treatment of lung cancer and OSA, we hope to understand the relationships between the two and promote the interdisciplinary exchange of ideas between basic medicine, clinical medicine, respiratory medicine, sleep medicine, and oncology.