Association between obstructive sleep apnoea and cancer: a cross-sectional, population-based study of the DISCOVERY cohort

Swedish national cohort of children living with long-term respiratory support (DISCOVERY-P): cohort profile

PURPOSE

Children living with respiratory support rely on medical technology, either fully or partially, throughout the day to meet their breathing requirements. Although children and young people living with respiratory support at home undergo long-term treatments and make extensive use of health and social care services, there is a notable absence of comprehensive outcome data on this group. The establishment of the first nationwide Course of DISease reported to the Swedish CPAP Oxygen and VEntilator RegistrY paediatrics cohort aims to investigate the disease trajectory, clinical and socioeconomic risk factors influencing incident illness, hospitalisation risk and mortality among children living with respiratory support.

PARTICIPANTS

Data on patients aged 0-18 years reported to the Swedish National Registry for Respiratory Failure and Sleep Apnoea (Swedevox) 1 January 2015 to 29 July 2021 were merged with seven quality or governmental registries, the National Quality Registry for Intensive Care, the National Medical Birth Register, the Swedish Cause of Death Registry, the Registry for Interventions under the Act on Support and Service to Certain Disabled Persons, the Swedish National Patient Registry and with socioeconomic data from Total Population Registry and Longitudinal Integrated Database for health insurance and labour market studies.

FINDINGS TO DATE

The cohort includes 716 children, 59% male, who began respiratory support at an average age of 6.4 years (SD 5.4). Among them, 28% use continuous positive airway pressure, 64% long-term mechanical ventilation (LTMV), 3% high-flow oxygen therapy (HFOT) and 5% other methods. Respiratory support is mostly used at night, but many LTMV (54%) and HFOT (81%) users need daytime aid. 77% of LTMV users rely on mask connection, differing from international data.

FUTURE PLANS

Future projects include exploring the impact of socioeconomic factors on hospitalisation rates and mortality. The dataset is due for an update in 2026.

MiRNA expression affects survival in patients with obstructive sleep apnea and metastatic colorectal cancer

INTRODUCTION

The relationship between obstructive sleep apnea (OSA) and cancer has been recognized for some time now. However, little is known about the mechanisms by which sleep apnea promotes tumorigenesis and the impact of OSA on survival after cancer diagnosis. In the last few years, research has focused on the exploration of different biomarkers to understand the mechanisms underlying this relationship and miRNAs, non-coding single strands of about 22 nucleotides that post-transcriptionally regulate gene expression, have emerged as possible actors of this process.The aim of the study was to evaluate the impact of OSA on survival of metastatic colorectal cancer (mCRC) patients based on the expression of specific miRNAs.

METHODS

The expression of 6 miRNAs, respectively miR-21, miR-23b, miR-26a, miR-27b, miR-145 and miR-210, was analyzed by qRT-PCR in patients' sera. Response to first-line therapy, Kaplan-Meier curves of overall and progression-free survival were used to evaluate survival in mCRC patients with and without OSA stratified for the expression of miRNAs.

RESULTS

The expression of miR-21, miR-23b, miR-26a and miR-210 was significantly upregulated in mCRCs with OSA compared to no OSA. In mCRC patients with OSA and increasing expression of miR-21, miR-23b, miR-26a and miR-210 risk of progression after first-line therapy was higher and both overall and progression-free survival were significantly worst. Conversely, as miR-27b and miR-145 expression increased, the life expectancy of patients diagnosed with OSA and mCRC improved markedly.

CONCLUSIONS

This study highlights the relevance of specific miRNAs on OSA in mCRCs and their significance as non-invasive biomarkers in predicting the prognosis in patients with mCRC and OSA.

STAT6 deficiency mitigates the severity of pulmonary arterial hypertension caused by chronic intermittent hypoxia by suppressing Th2-inducing cytokines

BACKGROUND

Obstructive sleep apnea (OSA) is frequently associated with increased incidence and mortality of pulmonary hypertension (PH). The immune response contributes to pulmonary artery remodeling and OSA-related diseases. The immunologic factors linked to OSA-induced PH are not well understood. STAT6 is crucial in the signaling pathway that modulates immune response. However, the status of phosphorylated STAT6 (p-STAT6) in an OSA-induced PH mouse model remains largely unexplored.

METHODS

Chronic intermittent hypoxia (CIH) plays a crucial role in the progression of OSA. This study utilized a in vivo CIH model to examine the role of STAT6 in CIH-induced PH.

RESULTS

CIH mice exhibited pulmonary artery remodeling and pulmonary hypertension, indicated by increased right ventricular systolic pressure (RVSP), higher right ventricular to left ventricular plus septum (RV/LV + S) ratios, and significant morphological alterations compared to normoxic (Nor) mice. Increased p-STAT6 in the lungs and elevated p-STAT6 + IL-4 + producing T cells in CIH mice. STAT6 deficiency (STAT6-/-) improved PH and PA remodeling in CIH-induced PH mouse models.STAT6 deficiency impaired the T helper 2 (Th2) immune response, affecting IL-4 and IL-13 secretion. IL-4, rather than IL-13, activated STAT6 in human pulmonary artery smooth muscle cells (hPASMCs). STAT6 knockdown decreased the proliferation in IL-4 treated hPASMCs.

CONCLUSION

These findings exhibit the critical role of STAT6 in the pathogenesis of CIH induced PH by regulating Th2 immune response.STAT6 could be a significant therapeutic target for OSA-related PH.

Relationship between REI and PSA in patients with obstructive sleep apnea: a prospective case-control study

BACKGROUND

Obstructive sleep apnea has been associated with various urinary system diseases, including prostatic hyperplasia and nocturia. Recently, it has been linked to prostate cancer. This study investigated the relationship between the apnea hypopnea index, prostate-specific antigen (PSA) levels, and changes in PSA.

METHODS

A total of 673 male patients who received portable sleep monitoring were assessed. All participants underwent thorough health assessments, including PSA testing. Individuals in Study 1 were divided into OSA and control groups based on an REI (Respiratory event index) ≥ 15 events/h. In Study 2, 176participants from the initial study were retested for PSA after three years.

RESULTS

In Study 1, patients with OSA had significantly higher ln-transformed PSA levels than controls (P < 0.05). Ln-transformed PSA levels showed a positive correlation with the REI (r = 0.184, p = 0.015). In Study 2, after three years, the ln-transformed PSA level increased by 0.13 ng/ml in the OSA group, while it decreased by -0.05 ng/ml in the control group. The change in ln-transformed PSA was significantly higher in patients with OSA (p = 0.014). Even after adjusting for age, body mass index (BMI), smoking, hypertension, and diabetes, REI remained a significant predictor of PSA level changes (β = 0.226, 95% CI = 0.001-0.009; p = 0.008).

CONCLUSIONS

This study highlights the close relationship between REI and PSA levels in individuals with obstructive sleep apnea, indicating that REI is an independent risk factor for PSA levels. Obstructive sleep apnea may be associated with the incidence of prostate cancer.

The Swedish sleep apnea registry (SESAR) cohort - "Real world data" on a national level

INTRODUCTION

The Swedish Sleep Apnea Registry (SESAR) collects clinical data from individual obstructive sleep apnea (OSA) patients since 2010. SESAR has recently been integrated with additional national healthcare data. The current analysis presents the SESAR structure and representative clinical data of a national sleep apnea cohort.

METHODS

Clinical data from unselected patients with a diagnosis of OSA are submitted to the SESAR registry. 48 sleep centers report data from diagnosis, treatment starts with Continuous Positive Airway Pressure (CPAP), oral devices (OD), and Upper Airway Surgery (UAS). Data from follow-up are included. SESAR is linked to mandatory national healthcare data (mortality, comorbidities, procedures, prescriptions) and diagnosis-specific quality registries (e.g. stroke, heart failure, diabetes) within the DISCOVERY project.

RESULTS

83,404 OSA patients have been reported during the diagnostic workup (age 55.4 ± 14.1 years, BMI 30.8 ± 6.5 kg/m2, AHI 25.8 ± 21.6n/h, respectively). At least one cardiometabolic and respiratory comorbidity is recognized in 57 % of female and 53 % of male OSA patients with a linear increase across OSA severity. In 54,468, 7,797, and 390 patients, start of CPAP, OD or UAS treatment is reported, respectively. OD patients have 4 units lower BMI and 10 units lower AHI compared to patients started on CPAP. UAS patients are characterized by 10 years lower age. The degree of daytime sleepiness is comparable between treatment groups with mean Epworth Sleepiness Scale Scores between 9 and 10.

CONCLUSION

SESAR is introduced as a large national registry of OSA patients. SESAR provides a useful tool to highlight OSA management and to perform relevant outcome research.

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.

[Sleep disorders and oncological diseases]

The study of neurological symptoms and signs connected with neoplasms and antitumor therapy is relevant in the context of an increasing prevalence of cancer. The COVID-19 pandemic and social factors have increased the number of patients suffering from insomnia. Sleep disorders is an unfavorable prognostic factor for neoplasms. The review presents risk factors and mechanisms of sleep disturbance, their relationship with inflammation and dysfunction of the immune system in cancer. In particular, dysfunction of the melatonergic system is discussed as a risk factor for the development of insomnia and cancer. The relevance of developing measures aimed at the rehabilitation of patients in order to restore normal sleep, which plays a fundamental role in maintaining a person's mental and physical health, is emphasized.