Department of Medicine, and.
ICES, Ottawa and Toronto, Ontario, Canada.
Ann Am Thorac Soc. 2022 May;19(5):807-818. doi: 10.1513/AnnalsATS.202106-738OC.
The evidence for an association between cancer survival and obstructive sleep apnea (OSA) remains underexplored. To evaluate an association between markers of OSA severity (respiratory disturbances, hypoxemia, and sleep fragmentation) and cancer-related mortality in individuals with previously diagnosed cancer. We conducted a multicenter retrospective cohort study using linked clinical and provincial health administrative data on consecutive adults who underwent a diagnostic sleep study between 1994 and 2017 in four Canadian academic hospitals and were previously diagnosed with cancer through the Ontario Cancer Registry. Multivariable cause-specific Cox regressions were used to address the research objective. We included 2,222 subjects. Over a median follow-up time of 5.6 years (interquartile range [IQR], 2.7-9.1 years), 261/2,222 (11.7%) individuals with prevalent cancer died from cancer-related causes, which accounted for 44.2% (261/590) of all-cause death. Controlling for age, sex, alcohol use disorder, prior heart failure, chronic obstructive pulmonary disease, hypertension, diabetes, treatment for OSA, clinic site, year of the sleep study, and time since the cancer diagnosis, measures of hypoxemia and sleep fragmentation, but not apnea-hypopnea index, were significantly associated with the cancer-specific mortality: percentage of time spent with arterial oxygen saturation (Sa) < 90% (hazard ratio [HR] per 5% increase, 1.05; 95% confidence interval, 1.01-1.09); mean Sa (HR per 3% increase, 0.79; 0.68-0.92); and percentage of stage 1 sleep (HR per 16% increase, 1.27; 1.07-1.51). In a large clinical cohort of adults with suspected OSA and previously diagnosed cancer, measures of nocturnal hypoxemia and sleep fragmentation as markers of OSA severity were significantly associated with cancer-related mortality, suggesting the need for more targeted risk awareness.
癌症生存与阻塞性睡眠呼吸暂停（OSA）之间的关联证据仍未得到充分探索。本研究旨在评估 OSA 严重程度标志物（呼吸紊乱、低氧血症和睡眠碎片化）与先前确诊癌症个体的癌症相关死亡率之间的关联。我们进行了一项多中心回顾性队列研究，使用加拿大四所学术医院在 1994 年至 2017 年期间进行的诊断性睡眠研究的连续成人患者的临床和省级健康行政数据，并通过安大略省癌症登记处先前确诊为癌症。使用多变量特定原因 Cox 回归来解决研究目标。我们纳入了 2222 名受试者。在中位随访时间为 5.6 年（四分位距[IQR]，2.7-9.1 年）期间，2222 名患有癌症的患者中有 261/2222（11.7%）死于癌症相关原因，占所有原因死亡的 44.2%（261/590）。在校正年龄、性别、酒精使用障碍、既往心力衰竭、慢性阻塞性肺疾病、高血压、糖尿病、OSA 治疗、诊所地点、睡眠研究年份和癌症诊断后时间后，低氧血症和睡眠碎片化的测量指标，但不是呼吸暂停低通气指数，与癌症特异性死亡率显著相关：动脉血氧饱和度（Sa）<90%的时间百分比（每增加 5%的危险比[HR]，1.05；95%置信区间，1.01-1.09）；平均 Sa（每增加 3%的 HR，0.79；0.68-0.92）；和 stage 1 睡眠的百分比（每增加 16%的 HR，1.27；1.07-1.51）。在一个有疑似 OSA 和先前确诊癌症的大型临床队列中，作为 OSA 严重程度标志物的夜间低氧血症和睡眠碎片化测量指标与癌症相关死亡率显著相关，这表明需要更有针对性的风险意识。
