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Martinez-Garcia MA, Campos-Rodriguez F, Nagore E, Martorell A, Rodriguez-Peralto JL, Riveiro-Falkenbach E, Hernandez L, Bañuls J, Arias E, Ortiz P, Cabriada V, Gardeazabal J, Montserrat JM, Carrera C, Corral J, Masa JF, de Terreros JG, Abad J, Boada A, Mediano O, de Eusebio E, Chiner E, Landete P, Mayos M, Fortuño A, Barbé F, Sánchez de la Torre M, Sanchez de la Torre A, Cano I, Gonzalez C, Pérez-Gil A, Gómez-García T, Cullen D, Somoza M, Formigón M, Aizpuru F, Navarro C, Selma-Ferrer MJ, Garcia-Ortega A, de Unamuno B, Almendros I, Farré R, Gozal D. Sleep-Disordered Breathing Is Independently Associated With Increased Aggressiveness of Cutaneous Melanoma: A Multicenter Observational Study in 443 Patients. Chest 2018; 154:1348-1358. [PMID: 30059679 DOI: 10.1016/j.chest.2018.07.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/22/2018] [Accepted: 07/10/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) has been associated with a greater incidence and mortality of cancer, although such findings are inconsistent. However, no large studies are currently available to investigate this association in patients with a specific type of cancer. This study seeks to assess potential relationships between SDB severity and aggressiveness markers of cutaneous melanoma. METHODS Four hundred and forty-three patients with a diagnosis of melanoma underwent a sleep study within 6 months of diagnosis. General demographics were collected, along with melanoma characteristics and polygraphic parameters consisting of the apnea-hypopnea index (AHI) and indices of both continuous and intermittent night-time oxyhemoglobin desaturation (DI4%). An exploration of independent relationships between SDB and various objective melanoma aggressiveness markers (Breslow index, presence of ulceration, presence of regression, mitotic index, stage of severity, damage to the sentinel lymph, and spreading of the melanoma) was performed. RESULTS Patients in the upper tertiles of AHI or DI4% were 1.94 (95% CI, 1.14-3.32; P = .022) and 1.93 (95% CI, 1.14-3.26; P = .013) times more likely, respectively, to present with aggressive melanoma (Breslow index > 1 mm) than those in the lowest tertiles of these sleep attributes after adjustment for age, sex, tumor location, and BMI. This association was particularly prominent among patients < 56 years of age with Breslow index > 2 mm. The presence of the additional markers of aggressiveness was also associated with higher AHI and DI4% values. CONCLUSIONS The severity of SDB was independently associated with greater aggressiveness of cutaneous melanoma, particularly among younger patients.
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Affiliation(s)
| | | | - Eduardo Nagore
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | | | | | | | - Luis Hernandez
- Respiratory Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Jose Bañuls
- Dermatology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Eva Arias
- Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo Ortiz
- Dermatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Valentin Cabriada
- Respiratory Department, Hospital Universitario Cruces de Bilbao, Bilbao, Spain
| | - Jose Gardeazabal
- Dermatology Department, Hospital Universitario Cruces de Bilbao, Bilbao, Spain
| | - Josep Maria Montserrat
- Respiratory Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Cristina Carrera
- Dermatology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Jaime Corral
- Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Juan Fernando Masa
- Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Javier Gomez de Terreros
- Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Jorge Abad
- Respiratory Department, Hospital Universitario Germans Trials I Pujol, Barcelona, Spain
| | - Adam Boada
- Dermatology Department, Hospital Universitario Germans Trials I Pujol, Barcelona, Spain
| | - Olga Mediano
- Respiratory Department, Hospital Universitario General de Guadalajara, Guadalajara, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Esther de Eusebio
- Dermatology Department, Hospital Universitario General de Guadalajara, Guadalajara, Spain
| | - Eusebi Chiner
- Respiratory Department, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Pedro Landete
- Respiratory Department, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Mercedes Mayos
- Respiratory Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Ana Fortuño
- Respiratory Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Ferrán Barbé
- Respiratory Department, IRBLleida, Lleida, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Manuel Sánchez de la Torre
- Respiratory Department, IRBLleida, Lleida, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Alicia Sanchez de la Torre
- Respiratory Department, IRBLleida, Lleida, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Irene Cano
- Respiratory Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Cristina Gonzalez
- Dermatology Department, Hospital Universitario de Getafe, Madrid, Spain
| | | | - Teresa Gómez-García
- Respiratory Department, Fundación Jimenez Diaz, Madrid, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Daniela Cullen
- Dermatology Department, Fundación Jimenez Diaz, Madrid, Spain
| | - Maria Somoza
- Respiratory Department, Consorcio Sanitario Terrassa, Barcelona, Spain
| | - Manuel Formigón
- Dermatology Department, Consorcio Sanitario Terrassa, Barcelona, Spain
| | - Felipe Aizpuru
- Biostatistical Service, BioAraba, Health Research Institute, OSI Araba University Hospital, Basque Health Service, University of the Basque Country, Bilbao, Spain
| | - Cristina Navarro
- Respiratory Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | | | | | - Blanca de Unamuno
- Dermatology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain, and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Ramón Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain, and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - David Gozal
- Department of Pediatrics, University of Chicago, Chicago, IL
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