1
|
Theorell-Haglöw J, Zhou X, Wittert G, Adams R, Appleton S, Reynolds A, Ljunggren M, Marshall N. Does obstructive sleep apnea increase the risk of cancer and cancer mortality in combined community-based cohorts? J Sleep Res 2023:e14089. [PMID: 37990480 DOI: 10.1111/jsr.14089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 11/23/2023]
Abstract
Obstructive sleep apnea (OSA) has been linked to cancer in several clinical and community-based cohorts. The effect in community-based studies free of clinical referral bias needs to be replicated. In this observational prospective cohort study, we pooled data from three community-based prospective cohorts (Uppsala Sleep and Health in Men cohort [UMEN]; Sleep and health in women [SHE]; Men Androgen Inflammation Lifestyle Environment and Stress Cohort [MAILES]; nTotal = 1467). All cohorts had objective data on obstructive sleep apnea and registry linkage data on cancer and cancer mortality. Analyses for different obstructive sleep apnea measures (apnea-hypopnea index [AHI], oxygen desaturation index [ODI], and minimal saturation) as risk factors for cancer incidence (all cancers) were performed using Cox proportional hazards models (follow-up 5-16 years). We did not find an overall increased risk of cancer after adjustment for age, sex, and BMI (HRAHI [95% CI] = 1.00 [0.98; 1.01] and HRODI [95% CI] = 0.99 [0.97; 1.01]). Stratifying by daytime sleepiness did not influence the association. Cancer mortality was not significantly associated with obstructive sleep apnea. Taken together, we did not observe an overall increased risk of cancer or cancer mortality in relation to obstructive sleep apnea, however, our confidence limits remain wide for important diagnostic categories of sleep apnea severity. The relationship between obstructive sleep apnea and cancer needs further investigation in a comprehensive multi-cohort approach with greater statistical precision. For future studies we may need to find and then combine every community-based cohort study that can provide a definitive answer to the question on the risk of cancer from obstructive sleep apnea in the general population.
Collapse
Affiliation(s)
- Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Xingwu Zhou
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Gary Wittert
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Robert Adams
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute - Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Sarah Appleton
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute - Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Amy Reynolds
- Flinders Health and Medical Research Institute - Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Nathaniel Marshall
- Centre for Research and Understanding of Sleep (CIRUS), Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
| |
Collapse
|