Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Sleep. 2021 Mar 12;44(3). doi: 10.1093/sleep/zsaa198.
Chronic intermittent hypoxia resulting from obstructive sleep apnea (OSA) may activate multiple carcinogenic pathways and lead to cancer development.
We prospectively examined the association between OSA and cancer risk among 65,330 women in the Nurses' Health Study who were free of cancer in 2008 (mean age: 73.3 years). Incident cancer diagnoses were collected until 2016 and confirmed by pathology reports. Clinically diagnosed OSA was self-reported in 2008 and updated in 2012. We used time-dependent Cox regression to estimate hazard ratios (HR) for the associations of OSA with total and site-specific cancer risk.
We documented 5,257 incident cancer diagnoses during follow-up. In the age-adjusted model, OSA was associated with a 15% (95% CI: 1.03, 1.29) increase in total cancer risk. The association became nonsignificant after adjustment for multiple cancer risk factors (HR: 1.08; 95% CI: 0.96, 1.21). When examining cancer risk by site, OSA was associated with significantly increased risk for lung (fully adjusted HR: 1.52; 95% CI: 1.07, 2.17), bladder (fully adjusted HR: 1.94; 95% CI: 1.12, 3.35), and thyroid cancer (fully adjusted HR: 2.06; 95% CI: 1.01, 4.22) and possibly increased risk for kidney cancer (fully adjusted HR: 1.59; 95% CI: 0.84, 3.01). When grouping cancer sites by risk factor profiles, OSA was positively associated with smoking-related cancers (fully adjusted HR: 1.37; 95% CI: 1.11, 1.67), and this association was stronger in never smokers than ever smokers.
While OSA was not independently associated with overall cancer risk in older women, significant associations were observed for smoking-related cancers, especially in nonsmokers.
阻塞性睡眠呼吸暂停（OSA）引起的慢性间歇性低氧可能激活多种致癌途径，导致癌症的发生。
我们前瞻性地研究了在 2008 年无癌症的 65330 名护士健康研究女性中，OSA 与癌症风险之间的关联，这些女性的平均年龄为 73.3 岁。在 2016 年之前收集了癌症的发病诊断，并通过病理报告确认。2008 年报告了临床诊断的 OSA，并在 2012 年进行了更新。我们使用时间依赖性 Cox 回归估计 OSA 与总癌症和特定部位癌症风险之间的关联的风险比（HR）。
在随访期间，我们记录了 5257 例新发癌症诊断。在年龄调整模型中，OSA 与总癌症风险增加 15%（95%CI：1.03，1.29）相关。在调整了多个癌症危险因素后，这种关联变得无统计学意义（HR：1.08；95%CI：0.96，1.21）。当按部位检查癌症风险时，OSA 与肺癌（完全调整的 HR：1.52；95%CI：1.07，2.17）、膀胱癌（完全调整的 HR：1.94；95%CI：1.12，3.35）和甲状腺癌（完全调整的 HR：2.06；95%CI：1.01，4.22）的风险显著增加相关，并且可能与肾癌（完全调整的 HR：1.59；95%CI：0.84，3.01）的风险增加相关。当按危险因素谱对癌症部位进行分组时，OSA 与与吸烟有关的癌症呈正相关（完全调整的 HR：1.37；95%CI：1.11，1.67），并且这种关联在从不吸烟者中比在吸烟者中更强。
虽然 OSA 与老年女性的总体癌症风险无独立相关性，但与吸烟相关的癌症显著相关，尤其是在不吸烟者中。
