Gozal David, Ham Sandra A, Mokhlesi Babak
Sections of Pediatric Sleep Medicine and Pulmonology, Department of Pediatrics, Prizkter School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL.
Center for Health and the Social Sciences, The University of Chicago, Chicago, IL.
Sleep. 2016 Aug 1;39(8):1493-500. doi: 10.5665/sleep.6004.
Epidemiological evidence from relatively small cohorts suggests that obstructive sleep apnea (OSA) is associated with higher cancer incidence and mortality. Here we aimed to determine whether cancer incidence for major cancer types and risk of metastases or mortality from cancer are increased in the presence of OSA.
All OSA diagnoses included in an employee-sponsored health insurance database spanning the years 2003-2012 were identified and 1:1 matched demographically based on age, gender, and state of residence, or alternatively matched by comorbidities. The incidence of 12 types of cancer was assessed. In addition, another cohort of patients with a primary diagnosis of cancer was retrieved, and the risk of metastatic disease or cancer mortality was determined as a function of the presence or absence of OSA. Multivariate Cox proportional hazards regression models were fitted to assess the independent associations between OSA and outcomes of interest.
Based on a cohort of ∼5.6 million individuals, the incidence of all cancer diagnoses combined was similar in OSA and retrospectively matched cases. However, the adjusted risk of pancreatic and kidney cancer and melanoma were significantly higher in patients with OSA, while the risk of colorectal, breast, and prostate cancers appeared to be lower. Among individuals with a diagnosis of cancer, the presence of OSA was not associated with an increased risk for metastasis or death.
In a large nationally representative health insurance database, OSA appears to increase the risk for only a very selective number of cancer types, and does not appear to be associated with an increased risk of metastatic cancer or cancer-related deaths.
来自相对较小队列的流行病学证据表明，阻塞性睡眠呼吸暂停（OSA）与较高的癌症发病率和死亡率相关。我们旨在确定在存在OSA的情况下，主要癌症类型的癌症发病率以及癌症转移风险或死亡率是否会增加。
识别出2003年至2012年期间员工赞助的健康保险数据库中包含的所有OSA诊断病例，并根据年龄、性别和居住州进行1:1人口统计学匹配，或者根据合并症进行匹配。评估了12种癌症的发病率。此外，检索了另一组初诊为癌症的患者队列，并根据是否存在OSA确定转移疾病或癌症死亡的风险。采用多变量Cox比例风险回归模型来评估OSA与感兴趣结局之间的独立关联。
基于约560万个体的队列，OSA组和回顾性匹配病例组中所有癌症诊断的合并发病率相似。然而，OSA患者中胰腺癌、肾癌和黑色素瘤的校正风险显著更高，而结直肠癌、乳腺癌和前列腺癌的风险似乎较低。在诊断为癌症的个体中，OSA的存在与转移或死亡风险增加无关。
在一个具有全国代表性的大型健康保险数据库中，OSA似乎仅增加了极少量特定癌症类型的风险，并且似乎与转移性癌症风险或癌症相关死亡风险增加无关。
