Wang Gang, Wang Jian-Jiang, Lin Chao-Huang, Zhou Qing, Wang Wei-Long, Qin Tao, Li Xin, Wang Ze-Jun
Department of Gastrointestinal Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang, China.
Department of Gastrointestinal surgery, the Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China.
J Gastrointest Oncol. 2022 Aug;13(4):1805-1817. doi: 10.21037/jgo-22-682.
Although studies have reported that certain sleep characteristics, such as sleep duration and sleep apnea, are linked to the risk of colorectal cancer (CRC), this link remains contentious because of the limited evidence from individual studies. Furthermore, evidence indicated that shift work involving circadian disruption as a probable human carcinogen. This systematic review and meta-analysis aimed to examine the associations between sleep duration, sleep apnea, and shift work with the risk of colorectal neoplasms, including CRC and colorectal adenoma (CRA).
We conducted a comprehensive literature search in PubMed, Embase, and Web of Science databases. The inclusion criteria were determined using PICOS principles. Observational studies reporting associations of sleep duration, sleep apnea, or shift work with risk of CRC or CRA were included. We assessed the risk of bias on the basis of the Newcastle-Ottawa Scale.
A total of 18 observational studies were included. Of these studies, nine studies reported the effect of sleep duration on risk of colorectal neoplasms, five reported the effect of sleep apnea, and six reported the effect of shift work. The relative risk (RR) for colorectal neoplasms was 1.06 [95% confidence interval (CI): 0.94, 1.20] in the short sleep duration group compared with the moderate sleep duration group. Long sleep duration was associated with an increased risk of colorectal neoplasms (RR: 1.33, 95% CI: 1.07, 1.65). The pooled results showed that sleep apnea was associated with an increased risk of colorectal neoplasms (RR: 1.75, 95% CI: 1.56, 1.97). Furthermore, results showed that the association between shift work and the risk of colorectal neoplasms was not significant (RR: 1.06, 95% CI: 0.95, 1.17). No publication bias was observed in all the analyses (all P>0.05). The sensitivity analysis showed that no individual study substantially influenced the pooled RRs for colorectal neoplasms and CRC.
Our findings suggest the significant positive association of long sleep duration and sleep apnea with risk of colorectal neoplasms and CRC. Given that sleep characteristics may be a potentially modifiable risk factor for colorectal neoplasms, further understanding of its role in carcinogenesis will provide valuable insight for cancer prevention.
尽管有研究报告称某些睡眠特征，如睡眠时间和睡眠呼吸暂停，与结直肠癌（CRC）风险相关，但由于个体研究证据有限，这种关联仍存在争议。此外，有证据表明，涉及昼夜节律紊乱的轮班工作可能是一种人类致癌物。本系统评价和荟萃分析旨在研究睡眠时间、睡眠呼吸暂停和轮班工作与结直肠肿瘤（包括CRC和结直肠腺瘤（CRA））风险之间的关联。
我们在PubMed、Embase和Web of Science数据库中进行了全面的文献检索。纳入标准根据PICOS原则确定。纳入报告睡眠时间、睡眠呼吸暂停或轮班工作与CRC或CRA风险之间关联的观察性研究。我们根据纽卡斯尔-渥太华量表评估偏倚风险。
共纳入18项观察性研究。其中，9项研究报告了睡眠时间对结直肠肿瘤风险的影响，5项报告了睡眠呼吸暂停的影响，6项报告了轮班工作的影响。与中等睡眠时间组相比，短睡眠时间组结直肠肿瘤的相对风险（RR）为1.06[95%置信区间（CI）：0.94，1.20]。长睡眠时间与结直肠肿瘤风险增加相关（RR：1.33，95%CI：1.07，1.65）。汇总结果显示，睡眠呼吸暂停与结直肠肿瘤风险增加相关（RR：1.75，95%CI：1.56，1.97）。此外，结果显示轮班工作与结直肠肿瘤风险之间的关联不显著（RR：1.06，95%CI：0.95，1.17）。所有分析均未观察到发表偏倚（所有P>0.05）。敏感性分析表明，没有个体研究对结直肠肿瘤和CRC的汇总RR有实质性影响。
我们的研究结果表明，长睡眠时间和睡眠呼吸暂停与结直肠肿瘤和CRC风险之间存在显著正相关。鉴于睡眠特征可能是结直肠肿瘤潜在的可改变风险因素，进一步了解其在致癌过程中的作用将为癌症预防提供有价值的见解。
