Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR).
Sleep Disordered Breathing Clinic, PROMISE Department, University of Palermo, Palermo, Italy.
Curr Opin Pulm Med. 2020 Nov;26(6):657-667. doi: 10.1097/MCP.0000000000000729.
Obstructive sleep apnea (OSA) has been recognized as a risk factor for cancer mainly through hypoxia, based on studies that did not distinguish among cancer types. The purpose of this review is to discuss the most recent data on epidemiology and pathophysiology of the OSA-cancer association.
According to epidemiological studies, OSA may have different influences on each type of cancer, either increasing or decreasing its incidence and aggressiveness. Time spent with oxygen saturation below 90% appears the polysomnographic variable most strongly associated with unfavorable effects on cancer. Experimental studies support the role of hypoxia as an important risk factor for cancer growth and aggressiveness, especially when it shows an intermittent pattern. These effects are largely mediated by the hypoxia-inducible factor, which controls the synthesis of molecules with effects on inflammation, immune surveillance and cell proliferation. Sleep fragmentation participates in increasing cancer risk. Modulating effects of age remain controversial.
Effects of OSA on cancer may largely vary among neoplastic diseases, both in their magnitude and direction. The worse risk associated with intermittent rather than persistent hypoxia, and the effects of OSA therapy on cancer natural history are still poorly known, and deserve new careful studies.
阻塞性睡眠呼吸暂停（OSA）被认为是癌症的一个危险因素，主要是基于没有区分癌症类型的研究发现其与缺氧有关。本文的目的是讨论 OSA 与癌症之间关联的最新流行病学和病理生理学数据。
根据流行病学研究，OSA 可能对每种类型的癌症有不同的影响，无论是增加还是降低其发病率和侵袭性。血氧饱和度低于 90%的时间似乎是与癌症不良影响最相关的多导睡眠图变量。实验研究支持缺氧作为癌症生长和侵袭性的重要危险因素的作用，尤其是当它呈现间歇性模式时。这些影响在很大程度上是由缺氧诱导因子介导的，它控制着对炎症、免疫监测和细胞增殖有影响的分子的合成。睡眠片段化参与增加癌症风险。年龄的调节作用仍存在争议。
OSA 对癌症的影响在不同的肿瘤疾病中可能有很大的差异，无论是在程度还是方向上。与持续缺氧相比，间歇性缺氧与更差的风险相关，OSA 治疗对癌症自然史的影响仍知之甚少，值得进一步仔细研究。
