Association between Obstructive Sleep Apnea and Cancer Incidence in a Large Multicenter Spanish Cohort
Francisco Campos-Rodriguez1, Miguel A. Martinez-Garcia2,3, Montserrat Martinez3,4, Joaquin Duran-Cantolla3,5, Monica de la Peña3,6, María J. Masdeu3,7, Monica Gonzalez8, Felix del Campo3,9, Inmaculada Gallego10, Jose M. Marin3,11, Ferran Barbe3,12, Jose M. Montserrat3,13, Ramon Farre3,14, and on behalf of the Spanish Sleep Network
1Respiratory Department and 10Oncology Department, Hospital Universitario de Valme, Sevilla, Spain 2Respiratory Department, Hospital Universitario y Politécnico La Fé, Valencia, Spain 3CIBER de Enfermedades Respiratorias, Bunyola, Spain 4Statistical Department, IRB Lleida, Lleida, Spain 5Research Department, Hospital Universitario Araba, Vitoria, Spain 6Respiratory Department, Hospital Universitario Son Espasses, Palma de Mallorca, Spain 7Respiratory Department, Hospital Parc Tauli, Sabadell, Spain 8Respiratory Department, Hospital Marques de Valdecilla, Santander, Spain 9Respiratory Department, Hospital Rio Hortega, Valladolid, Spain 11Respiratory Department, Hospital Miguel Servet, Zaragoza, Spain 12Respiratory Department, Hospital Arnau de Vilanova, IRB Lleida, Lleida, Spain 13Respiratory Department, Hospital Clinic, Barcelona, Spain; and 14Facultat de Medicina, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
Rationale: Obstructive sleep apnea (OSA) has been associated with increased cancer mortality, but whether it is also associated with cancer incidence is unknown.
Objectives: To investigate whether OSA is associated with increased cancer incidence in a large clinical cohort.
Methods: A multicenter, clinical cohort study including consecutive patients investigated for suspected OSA between 2003 and 2007 in seven Spanish teaching hospitals. Apnea-hypopnea index (AHI) and percent nighttime with oxygen saturation less than 90% (TSat90) were used as surrogates of OSA severity, both as continuous variables and categorized by tertiles. Cox proportional hazards regression analyses were used to calculate hazard ratio (HR) and 95% confidence interval (CI) for cancer incidence after adjusting for confounding variables.
Measurements and Main Results: A total of 4,910 patients were analyzed (median follow-up, 4.5 yr; interquartile range, 3.4–5.2). Compared with the lower TSat90 category (<1.2%), the adjusted hazards (95% CI) of cancer incidence for increasing categories were 1.58 (1.07–2.34) for TSat90 1.2–12% and 2.33 (1.57–3.46) for TSat90 greater than 12%. Continuous TSat90 was also associated with cancer incidence (adjusted HR, 1.07 [1.02–1.13] per 10-unit increase in TSat90). In stratified analyses, TSat90 was associated with cancer incidence in patients younger than 65 years (adjusted HR, 1.13 [95% CI, 1.06–1.21] per 10-unit increase in TSat90) and males (adjusted HR, 1.11 [95% CI, 1.04–1.17] per 10-unit increase in TSat90). AHI was not associated with cancer incidence in the adjusted analyses, except for patients younger than 65 years (adjusted HR for AHI >43 vs. <18.7, 1.66; 95% CI, 1.04–2.64).
Conclusions: Increased overnight hypoxia as a surrogate of OSA severity was associated with increased cancer incidence. This association seems to be limited to men and patients younger than 65 years of age.
Keywords:sleep apnea syndromes, intermittent hypoxia, cancer, sex, age
Am J Respir Crit Care Med Vol 187, Iss.1, pp 99-105, Jan 1, 2013
Copyright © 2013 by the American Thoracic Society
Originally Published in Press as DOI: 10.1164/rccm.201209-1671OC on November 15, 2012
Internet address: www.atsjournals.org