Genetically predicted insomnia and lung cancer risk: a Mendelian randomization study

Sleep, Circadian Rhythms, and Lung Cancer

Lung cancer is the leading cause of cancer-related mortality worldwide, with the prevalence of the disease continually rising. Therefore, identifying disease-modifying risk factors is critical, with increasing recognition of the impact of sleep quality/sleep disorders. This narrative review summarizes the evidence on the role of five domains of sleep on lung cancer incidence and progression: (i) sleep quality/duration, (ii) sleep disordered breathing, (iii) circadian rhythm disturbances, (iv) sleep-related movement disorders, and (v) personal, environmental, and social factors that modulate each of these associations. Epidemiological evidence supports reduced sleep duration, increased sleep duration, poor sleep quality, insomnia, obstructive sleep apnea, evening chronotype, peripheral limb movements in sleep, and less robustly for night shift work and restless leg syndrome to be associated with increased risk of lung cancer development, with potential impacts on cancer survival outcomes. Proposed mechanisms underlying the biological plausibility of these epidemiological associations are also explored, with common theories relating to immune dysregulation, metabolic alterations, reductions in melatonin, sympathetic overactivation, increased reactive oxygen species, production of protumorigenic exosomes, and inflammation. We also summarized potential treatments addressing impaired sleep quality/sleep disorders and their ability to attenuate the risk of lung cancer and improve cancer survival. Although evidence on reversibility is inconsistent, there are trends toward positive outcomes. Future research should focus on clinical trials to confirm cause and effect relationships, large epidemiologic studies for incidence/prognosis, clarification on the relative efficacy of treatment modalities, and more in vivo animal models to establish the molecular mechanisms underlying these relationships.

The role of sleep traits in prostate, endometrial, and epithelial ovarian cancers: An observational and Mendelian randomisation study

Background

Sleep traits may influence cancer risk; however, their associations with prostate (PCa), endometrial (ECa), and epithelial ovarian (EOCa) cancer remain unclear.

Methods

We conducted an observational analysis using the UK Biobank cohort and a two-sample Mendelian randomisation (MR) analysis to investigate the association of six sleep traits-duration, chronotype, insomnia, daytime napping, daytime sleepiness, and snoring-with PCa, ECa, and EOCa risk. Cox proportional hazards models were used for the observational analysis, while the inverse variance-weighted (IVW) method was applied in MR, with multiple sensitivity analyses. A Bonferroni correction accounted for multiple testing.

Results

Among 8,608 PCa, 1,079 ECa, and 680 EOCa incident diagnoses (median follow-up: 6.9 years), snoring was associated with reduced EOCa risk (HR=0.78, 95%CI: 0.62-0.98), while daytime sleepiness was associated with increased EOCa risk (HR=1.23, 95%CI: 1.03-1.47). However, these associations were not confirmed in MR. MR suggested higher odds of PCa (OR IVW =1.05, 95%CI: 1.01-1.11) and aggressive PCa (OR IVW =1.10, 95%CI: 1.02-1.19) for evening compared to morning chronotype. None of the findings survived multiple testing correction.

Conclusion

Sleep traits were not associated with PCa, ECa, or EOCa risk, but evening chronotype may increase PCa risk. Further research is needed to verify this association and investigate potential underlying mechanisms.

Impact

The proposed results have potential utility in reproductive cancer prevention.

What is already known on this topic

Sleep traits have been implicated in cancer risk, but their associations with prostate, endometrial, and epithelial ovarian cancer remain unclear.

What this study adds

This study found suggestive evidence that an evening chronotype may be associated with an increased risk of overall and aggressive prostate cancer.

How this study might affect research practice or policy

Further research is needed to confirm the potential association between chronotype and prostate cancer risk, which could inform personalised cancer prevention strategies.

Insomnia and Female Reproductive Diseases: A Cross-Sectional and Mendelian Randomization Study

Background

Insomnia is increasingly emerging as a significant concern in public health, with a longstanding emphasis on its relationship with overall well-being. Nevertheless, few research has been devoted to investigating the relationship between insomnia and female reproductive health.

Methods

In our study, we conducted a Mendelian randomization (MR) study to estimate the causal relationship between insomnia and female reproductive diseases. A total of 268 independent genetic variants associated with insomnia at the genome-wide significance level (P < 5×10-8) were used as instrumental variables. Summary-level data were obtained from the UK Biobank and Finn Gen study, including ovarian cysts, polycystic ovarian syndrome (PCOS), endometriosis, premature ovarian insufficiency (POI), ovarian cancer (OC), uterine fibroids, endometrial cancer (EC) and female infertility. We performed logistic regression to assess the associations between insomnia and the risk of OC and EC by using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014.

Results

Our research reveals that genetic liability to insomnia constitutes a risk factor for ovarian cysts (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.21-1.72, P< 0.05), PCOS (OR: 1.67, 95% CI: 1.44-1.94, P< 0.05), and endometriosis (OR: 1.43, 95% CI: 1.16-1.76, P< 0.05). However, we found no statistically significant associations between insomnia and POI, OC, uterine fibroids, EC, or female infertility. Additionally, body mass index (BMI) was found to mediate about 10% of the effect of the insomnia on ovarian cysts and PCOS. Moreover, in cross-sectional study, insomnia was not associated with OC and EC.

Conclusion

Our study provides causal evidence that genetically predicted insomnia increases the risk of ovarian cysts, PCOS, and endometriosis. Accordingly, the potential significance of weight control and good sleep in keeping fit need to be emphasized.

Genetic causality between insomnia and specific orthopedic conditions: Insights from a two-sample Mendelian randomization study

OBJECTIVE

To investigate the genetic causality for the insomnia and common orthopedic diseases, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), osteoporosis (OP), and gout (GT).

METHODS

The genome-wide association study (GWAS) summary data on insomnia were obtained from a published study, while the GWAS summary data on RA, AS, OP, and GT were sourced from the FinnGen consortium. We utilized the TwoSampleMR package of the R software (version 4.1.2) to conduct a two-sample Mendelian randomization (MR) analysis. Our primary method of analysis was the random-effects inverse variance weighted (IVW) approach. Subsequently, we conducted a series of sensitivity analyses for the MR analysis.

RESULTS

The MR analysis revealed a positive genetic causal relationship between insomnia and RA (P = 0.016, odds ratio [OR] 95 % confidence interval [CI] = 1.112 [1.020-1.212]). However, no significant genetic causal relationship was observed between insomnia and AS (P = 0.194, OR 95 % CI = 1.121 [0.944-1.331]), OP (P = 0.788, OR 95 % CI = 1.016 [0.904-1.142]), and GT (P = 0.757, OR 95 % CI = 1.018 [0.912-1.136]). The MR analysis did not exhibit heterogeneity, horizontal pleiotropy, outlier effects, or dependence on a single SNP, and demonstrated normal distribution, which guaranteed the robustness of the results.

CONCLUSION

The results of this study suggest that insomnia may be a significant risk factor for RA, and controlling insomnia may represent a promising strategy for preventing RA. While insomnia was not observed to be associated with AS, OP, and GT at the genetic level, other levels of association cannot be excluded.

The association between sleep quantity, insomnia and lung cancer risk - A systematic review and meta-analysis

PURPOSE

The effect of various sleep traits on the risk of lung cancer differs among pre-existing studies. This study aims to systematically review and synthesise the association between sleep duration and insomnia with the incidence of lung cancer.

METHODS

PubMed, Embase and The Cochrane Library were searched from inception to 23 April 2023 for observational studies examining the effect of sleep quantity or insomnia on lung cancer incidence. We pooled maximally-adjusted hazard ratios and odds ratios separately using random effects inverse variance weighted models. The risk of bias of observational studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

We included 11 observational studies with a pooled cohort of 5,049,141 patients. The mean age of the patients was 49.5 ± 17.7 years, and 51.4% were males. The risk of bias ranged from low-moderate. Individuals who slept for a shorter or longer duration than the reference range of sleep per night showed an increased risk of lung cancer by 11% (HR:1.11; 95%CI:1.00-1.23) and 16% (HR:1.16; 95%CI:1.06-1.27) respectively. Furthermore, individuals with insomnia symptoms had a 9% greater risk of lung cancer than those without symptoms (HR:1.09; 95%CI:1.05-1.13).

CONCLUSION

This study suggests that insufficient sleep, excessive sleep and insomnia may be associated with an increased risk of lung cancer. Physicians should be mindful of this association and encourage healthy sleep practises among patients. Given the observed heterogeneity among some pre-existing studies, future research with longer periods of follow-up, greater control for covariates and objective testing of sleep parameters may add value to this topic.

Disease Modules Associated with Unfavorable Sleep Patterns and Their Genetic Determinants: A Prospective Cohort Study of the UK Biobank

Despite the established associations between sleep-related traits and major diseases, comprehensive assessment on affected disease modules and their genetic determinants is lacking. Using multiple correspondence analysis and the k-means clustering algorithm, 235,826 eligible participants were clustered into distinct unfavorable sleep patterns [short sleep duration (n = 10,073), snoring (22,419), insomnia (102,771), insomnia and snoring (62,909)] and favorable sleep pattern groups (37,654). The associations of unfavorable sleep patterns with 134 diseases were estimated using Cox regression models; and comorbidity network analyses were applied for disease module identification. Genetic determinants associated with each disease module were identified by genome-wide association studies (GWAS). During an average follow-up of 10.80 years, unfavorable sleep patterns featured by 'short sleep duration', 'snoring', 'insomnia', and 'insomnia and snoring' were associated with increased risk of 0, 9, 10, and 19 diseases, respectively. Furthermore, comorbidity network analyses categorized these affected diseases into three disease modules, characterized by predominant diseases related to digestive system, circulatory and endocrine systems (snoring-related patterns only), and musculoskeletal system (insomnia-related patterns only). Using the number of affected diseases, as an index of a person's susceptibility to each disease module [i.e., susceptible score (SS)], GWAS analyses identified five, one, and three significant loci associated with the residual SS of these aforementioned disease modules, respectively, which mapped to several potential biological pathways, including those related to hormone regulation and catecholamine uptake. In conclusion, individuals with unfavorable sleep patterns, particularly snoring and insomnia, had increased risk of multiple diseases. The identification of three major disease modules with their relevant genetic determinants may facilitate strategy development for precision prevention of future health decline.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43657-023-00144-8.

Causal effects between personality and psychiatric traits and lung cancer: a bidirectional two-sample Mendelian randomization and bibliometric study

Introduction

The causality between personality and psychiatric traits and lung cancer (LC) remains unclear. Therefore, we aimed to elucidate the causality between these traits and LC.

Methods

Bidirectional two-sample Mendelian randomization (MR) and bibliometric approaches were conducted to estimate the causality between personality (neuroticism, extraversion, agreeableness, conscientiousness, and openness) and psychiatric (schizophrenia, attention-deficit/hyperactivity disorder [ADHD], major depressive disorder, autism spectrum disorder, bipolar disorder, insomnia, and anxiety) traits and LC and its subtypes (lung squamous cell carcinoma, lung adenocarcinoma, and small cell LC). Summary data of these traits were extracted from large datasets (17,375-462,341 participants). Inverse variance weighting was used as the primary MR analysis, with supplementary models, including MR-Egger and weighted medians. Sensitivity analyses were conducted to detect pleiotropy. Bibliometric data were retrieved from the Web of Science Core Collection, Scopus, and PubMed. The main mapping techniques adopted were co-word, collaboration, and citation analyses.

Results

Schizophrenia was associated with an increased risk of LC (odds ratio [OR] = 1.077, 95% confidence interval [CI] = 1.030-1.126, P = 0.001). Moreover, LC increased the risk of ADHD (OR = 1.221, 95% CI = 1.096-1.362, P < 0.001). No significant bidirectional associations were observed between other mental traits and LC and its subtypes. Causality, psychiatry, and psychiatric comorbidity are emerging keywords. Research dynamics and landscapes were revealed.

Conclusion

This study suggests that schizophrenia is a risk factor for LC and that LC is a risk factor for ADHD. Furthermore, causality, psychiatry, and psychiatric comorbidity have become emerging research trends in related fields.

Genetic correlation and causal associations between psychiatric disorders and lung cancer risk

BACKGROUND

Patients with certain psychiatric disorders have increased lung cancer incidence. However, establishing a causal relationship through traditional epidemiological methods poses challenges.

METHODS

Available summary statistics of genome-wide association studies of cigarette smoking, lung cancer, and eight psychiatric disorders, including attention deficit/hyperactivity disorder (ADHD), autism, depression, major depressive disorder, bipolar disorder, insomnia, neuroticism, and schizophrenia (range N: 46,350-1,331,010) were leveraged to estimate genetic correlations using Linkage Disequilibrium Score Regression and assess causal effect of each psychiatric disorder on lung cancer using two-sample Mendelian randomization (MR) models, comprising inverse-variance weighted (IVW), weighted median, MR-Egger, pleiotropy residual sum and outlier testing (MR-PRESSO), and a constrained maximum likelihood approach (cML-MR).

RESULTS

Significant positive correlations were observed between each psychiatric disorder and both smoking and lung cancer (all FDR < 0.05), except for the correlation between autism and lung cancer. Both univariable and the cML-MA MR analyses demonstrated that liability to schizophrenia, depression, ADHD, or insomnia was associated with an increased risk of overall lung cancer. Genetic liability to insomnia was linked specifically to squamous cell carcinoma (SCC), while genetic liability to ADHD was associated with an elevated risk of both SCC and small cell lung cancer (all P < 0.05). The later was further supported by multivariable MR analyses, which accounted for smoking.

LIMITATIONS

Participants were constrained to European ancestry populations. Causal estimates from binary psychiatric disorders may be biased.

CONCLUSION

Our findings suggest appropriate management of several psychiatric disorders, particularly ADHD, may potentially reduce the risk of developing lung cancer.

Inferring the genetic effects of serum homocysteine and vitamin B levels on autism spectral disorder through Mendelian randomization

PURPOSE

The previous studies have suggested that serum homocysteine (Hcy) and vitamin B levels are potentially related to autism spectrum disorder (ASD). However, the causality between their concentrations and ASD risk remains unclear. To elucidate this genetic association, we used a Mendelian randomization (MR) design.

METHODS

For this MR analysis, 47 single-nucleotide polymorphisms (SNPs)-13 related to Hcy, 13 to folate, 14 to vitamin B6, and 7 to vitamin B12-were obtained from a large-scale Genome-Wide Association Studies (GWAS) database and employed as instrumental variables (IVs). Our study used three approaches to calculate the MR estimates, including inverse-variance weighted (IVW) method, MR-Egger method, and weighted median (WM) method. Among these, the IVW method served as our primary MR method. False discovery rate (FDR) was implemented to correct for multiple comparisons. We also performed a series of sensitivity analyses, including Cochran's Q test, MR-Egger's intercept, MR-PRESSO, leave-one-out analysis, and the funnel plot.

RESULTS

Univariable Mendelian randomization (UVMR) analysis revealed a statistical association between serum vitamin B12 levels and ASD risk (OR = 1.68, 95% CI 1.12-2.52, P = 0.01) using the IVW method. However, neither the WM method (OR = 1.57, 95% CI 0.93-2.66, P = 0.09) nor the MR-Egger method (OR = 2.33, 95% CI 0.48-11.19, P = 0.34) was significantly association with higher levels of serum vitamin B12 and ASD risk. Additionally, we found no evidence of causal relationships between serum levels of vitamin B6, folate, Hcy, and ASD risk. After correcting for the FDR, the causality between serum vitamin B12 levels and ASD risk remained significant (q value = 0.0270). Multivariate Mendelian randomization (MVMR) analysis indicated an independent association between elevated serum vitamin B12 levels and the risk of ASD (OR = 1.74, 95% CI 1.03-2.95, P = 0.03) using the IVW method, but this finding was inconsistent when using the WM method (OR = 1.73, 95% CI 0.89-3.36, P = 0.11) and MR-Egger method (OR = 1.60, 95% CI 0.95-2.71, P = 0.08). Furthermore, no causal associations were observed for serum levels of vitamin B6 and folate in MVMR analysis. Sensitivity analyses confirmed that these results were reliable.

CONCLUSION

Our study indicated that elevated serum vitamin B12 levels might increase the risk of ASD. The potential implications of our results for ASD risk warrant validation in randomized clinical trials.

Potential genetic and epigenetic mechanisms in insomnia: A systematic review

Insomnia is a stress-related sleep disorder conceptualised within a diathesis-stress framework, which it is thought to result from predisposing factors interacting with precipitating stressful events that trigger the development of insomnia. Among predisposing factors genetics and epigenetics may play a role. A systematic review of the current evidence for the genetic and epigenetic basis of insomnia was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) system. A total of 24 studies were collected for twins and family heritability, 55 for genome-wide association studies, 26 about candidate genes for insomnia, and eight for epigenetics. Data showed that insomnia is a complex polygenic stress-related disorder, and it is likely to be caused by a synergy of genetic and environmental factors, with stress-related sleep reactivity being the important trait. Even if few studies have been conducted to date on insomnia, epigenetics may be the framework to understand long-lasting consequences of the interaction between genetic and environmental factors and effects of stress on the brain in insomnia. Interestingly, polygenic risk for insomnia has been causally linked to different mental and medical disorders. Probably, by treating insomnia it would be possible to intervene on the effect of stress on the brain and prevent some medical and mental conditions.

Hypoxia Induces Alterations in the Circadian Rhythm in Patients with Chronic Respiratory Diseases

The function of the circadian cycle is to determine the natural 24 h biological rhythm, which includes physiological, metabolic, and hormonal changes that occur daily in the body. This cycle is controlled by an internal biological clock that is present in the body's tissues and helps regulate various processes such as sleeping, eating, and others. Interestingly, animal models have provided enough evidence to assume that the alteration in the circadian system leads to the appearance of numerous diseases. Alterations in breathing patterns in lung diseases can modify oxygenation and the circadian cycles; however, the response mechanisms to hypoxia and their relationship with the clock genes are not fully understood. Hypoxia is a condition in which the lack of adequate oxygenation promotes adaptation mechanisms and is related to several genes that regulate the circadian cycles, the latter because hypoxia alters the production of melatonin and brain physiology. Additionally, the lack of oxygen alters the expression of clock genes, leading to an alteration in the regularity and precision of the circadian cycle. In this sense, hypoxia is a hallmark of a wide variety of lung diseases. In the present work, we intended to review the functional repercussions of hypoxia in the presence of asthma, chronic obstructive sleep apnea, lung cancer, idiopathic pulmonary fibrosis, obstructive sleep apnea, influenza, and COVID-19 and its repercussions on the circadian cycles.

Cancer-Related Dysfunctional Beliefs About Sleep Mediate the Influence of Sleep Disturbance on Fear of Progression Among Patients With Surgically Resected Lung Cancer

BACKGROUND

Lung cancer is associated with significant psychological distress, including fear of progression (FoP). Because insomnia and depression are highly prevalent and associated with FoP, we examined the association between FoP, insomnia, and depression in cancer patients. Furthermore, we tested the mediation effect of cancer-related dysfunctional beliefs about sleep (C-DBS) on this association.

METHODS

We analyzed data collected from patients with surgically resected non-small cell lung cancer from a single-center randomized controlled study investigating digital healthcare applications. Baseline demographic and clinical variables were collected. In addition, self-reported questionnaires including the Fear of Progression Questionnaire-Short Form, Patients Health Questionnaire-9 items (PHQ-9), Insomnia Severity Index, and C-DBS were administered.

RESULTS

Among the 320 enrolled patients with lung cancer, a regression model showed that FoP was predicted by age (β = -0.13, P = 0.007), PHQ-9 (β = 0.35, P < 0.001), and C-DBS (β = 0.28, P < 0.001). Insomnia did not directly influence FoP, but C-DBS mediated the association. Depression directly influenced FoP, but C-DBS did not mediate this association.

CONCLUSION

Among patients with surgically resected lung cancer, C-DBS mediated the effects of severity of insomnia on FoP. Depression directly influenced FoP, but C-DBS did not influence this association. To reduce FoP among patients with lung cancer, C-DBS should be addressed in the cognitive behavioral therapy module.

Clinical Spectrum and Trajectory of Innovative Therapeutic Interventions for Insomnia: A Perspective

Increasing incidences of insomnia in adults, as well as the aging population, have been reported for their negative impact on the quality of life. Insomnia episodes may be associated with neurocognitive, musculoskeletal, cardiovascular, gastrointestinal, renal, hepatic, and metabolic disorders. Epidemiological evidence also revealed the association of insomnia with oncologic and asthmatic complications, which has been indicated as bidirectional. Two therapeutic approaches including cognitive behavioral therapy (CBT) and drugs-based therapies are being practiced for a long time. However, the adverse events associated with drugs limit their wide and long-term application. Further, Traditional Chinese medicine, acupressure, and pulsed magnetic field therapy may also provide therapeutic relief. Notably, the recently introduced cryotherapy has been demonstrated as a potential candidate for insomnia which could reduce pain, by suppressing oxidative stress and inflammation. It seems that the synergistic therapeutic approach of cryotherapy and the above-mentioned approaches might offer promising prospects to further improve efficacy and safety. Considering these facts, this perspective presents a comprehensive summary of recent advances in pathological aetiologies of insomnia including COVID-19, and its therapeutic management with a greater emphasis on cryotherapy.

Insomnia and multiple health outcomes: umbrella review of meta-analyses of prospective cohort studies

OBJECTIVES

To evaluate existing evidence of prospective cohort studies on associations between insomnia and multiple health outcomes.

STUDY DESIGN

An umbrella review of meta-analyses of prospective cohort studies.

METHODS

A systematic search was undertaken in Pubmed, Embase, Cochrane, and Web of Science from inception to October 2021 to find meta-analyses of prospective cohort studies investigating the association of insomnia with any health outcome. The summary relative risk (SRR) for each meta-analysis was recalculated with random-effects model. The methodological quality and the quality of evidence were assessed by the A Measurement Tool to Assess Systematic Reviews and Grading of Recommendations, Assessment, Development and Evaluation, respectively.

RESULTS

A total of 25 published meta-analyses of prospective cohort studies, reporting 63 SRRs for 29 unique outcomes were included. Insomnia was mainly related to cardiovascular outcomes and mental disorders. The former comprised atrial fibrillation (SRR: 1.30, 95% confidence interval: 1.26 to 1.35), cardiovascular diseases (1.45, 1.29 to 1.64), coronary heart disease (1.28, 1.10 to 1.50), myocardial infarction (1.42, 1.17 to 1.72), and stroke (1.55, 1.39 to 1.72). The latter involved alcohol abuse (1.35, 1.08 to 1.67), all mental disorders (2.16, 1.70 to 3.97), anxiety (3.23, 1.52 to 6.85), depression (2.31, 1.90 to 2.81), suicidal ideation (2.26, 1.79 to 2.86), suicidal attempt (1.99, 1.31 to 3.02), and suicidal death (1.72, 1.42 to 2.08). Besides, insomnia enhanced the risk of Alzheimer's disease (1.51, 1.06 to 2.14) and hyperlipidemia (1.64, 1.53 to 1.76).

CONCLUSION

Insomnia exhibits considerable adverse outcomes, primarily comprises cardiovascular outcomes and mental disorders, but further studies with robustly designed trials are needed to draw firmer conclusions.

Risk of cancer in patients with insomnia: Nationwide retrospective cohort study (2009-2018)

PURPOSE

To investigate the association between insomnia and the risk of various cancers using the Korean National Health Insurance Service database.

MATERIALS AND METHODS

Patients who underwent a national health examination in 2009 were followed-up until 2018. Newly-diagnosed cancers were collected one year after the baseline. Insomnia was defined as having a diagnosis of F510 or G470 within one year prior to enrollment. The incidence of various cancers was compared between patients with and without insomnia.

RESULTS

In the overall study population (N = 3,982,012), the risk for any type of cancer was not different between controls and insomnia patients (adjusted hazard ratio [aHR]: 0.990). However, it was different by age; insomnia increased the risk of any cancer in younger age groups (20-39y and 40-59y, aHR:1.310 and 1.139, respectively) but it significantly decreased the risk in the 60-79y age group (aHR: 0.939). In cancer type, colorectal cancer risk was lower (aHR: 0.872, P < 0.0001), whereas leukemia risk was higher (aHR: 1.402, P < 0.0001) in patients with insomnia than in those without it, regardless of sex. In men, the risk of stomach cancer was lower (aHR: 0.882, P = 0.0003), and the risks of lung (aHR:1.114, P = 0.0005), kidney (aHR 1.226, P = 0.0107), and prostate (aHR:1.101, P = 0.0028) cancers were higher in insomnia patients than in control patients. In women, insomnia patients compared to control patients showed a lower risk of ovarian cancer (aHR:0.856, P = 0.0344, respectively), while they had a higher risk of oral (aHR:1.616, P = 0.002), thyroid (aHR:1.072, P = 0.0192), and nerve (aHR: 1.251, P = 0.016) cancers.

CONCLUSION

Insomnia is associated with an increased or decreased risk of some cancers, depending on age, cancer type and sex.

Leveraging genetic discoveries for sleep to determine causal relationships with common complex traits

Sleep occurs universally and is a biological necessity for human functioning. The consequences of diminished sleep quality impact physical and physiological systems such as neurological, cardiovascular, and metabolic processes. In fact, people impacted by common complex diseases experience a wide range of sleep disturbances. It is challenging to uncover the underlying molecular mechanisms responsible for decreased sleep quality in many disease systems owing to the lack of suitable sleep biomarkers. However, the discovery of a genetic component to sleep patterns has opened a new opportunity to examine and understand the involvement of sleep in many disease states. It is now possible to use major genomic resources and technologies to uncover genetic contributions to many common diseases. Large scale prospective studies such as the genome wide association studies (GWAS) have successfully revealed many robust genetic signals associated with sleep-related traits. With the discovery of these genetic variants, a major objective of the community has been to investigate whether sleep-related traits are associated with disease pathogenesis and other health complications. Mendelian Randomization (MR) represents an analytical method that leverages genetic loci as proxy indicators to establish causal effect between sleep traits and disease outcomes. Given such variants are randomly inherited at birth, confounding bias is eliminated with MR analysis, thus demonstrating evidence of causal relationships that can be used for drug development and to prioritize clinical trials. In this review, we outline the results of MR analyses performed to date on sleep traits in relation to a multitude of common complex diseases.

Non-small cell lung cancer in China

In China, lung cancer is a primary cancer type with high incidence and mortality. Risk factors for lung cancer include tobacco use, family history, radiation exposure, and the presence of chronic lung diseases. Most early-stage non-small cell lung cancer (NSCLC) patients miss the optimal timing for treatment due to the lack of clinical presentations. Population-based nationwide screening programs are of significant help in increasing the early detection and survival rates of NSCLC in China. The understanding of molecular carcinogenesis and the identification of oncogenic drivers dramatically facilitate the development of targeted therapy for NSCLC, thus prolonging survival in patients with positive drivers. In the exploration of immune escape mechanisms, programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitor monotherapy and PD-1/PD-L1 inhibitor plus chemotherapy have become a standard of care for advanced NSCLC in China. In the Chinese Society of Clinical Oncology's guidelines for NSCLC, maintenance immunotherapy is recommended for locally advanced NSCLC after chemoradiotherapy. Adjuvant immunotherapy and neoadjuvant chemoimmunotherapy will be approved for resectable NSCLC. In this review, we summarized recent advances in NSCLC in China in terms of epidemiology, biology, molecular pathology, pathogenesis, screening, diagnosis, targeted therapy, and immunotherapy.