阻塞性睡眠呼吸暂停与胃肠道癌症的发病率和死亡率：对5,120,837名参与者的系统评价和荟萃分析
Obstructive sleep apnea and the incidence and mortality of gastrointestinal cancers: a systematic review and meta-analysis of 5,120,837 participants.
作者信息
Teo Yao Hao, Tan Benjamin Kye Jyn, Tan Nicole Kye Wen, Yap Dominic Wei Ting, Chai Yi Xuen, Teo Yao Neng, Sia Ching-Hui, Sundar Raghav, Tan Emile, See Anna, Toh Song Tar
机构信息
Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
Department of Cardiology, National University Health System, Singapore, Singapore.
出版信息
J Gastrointest Oncol. 2022 Dec;13(6):2789-2798. doi: 10.21037/jgo-22-153.
BACKGROUND
Emerging evidence has shown higher overall cancer incidence in patients with obstructive sleep apnea. Gastrointestinal cancers, including esophageal, stomach, liver, pancreas, and colorectal cancers account for 26% of incident cancers. However, the link between gastrointestinal cancers and obstructive sleep apnea is still unclear. We performed a systematic review and meta-analysis (registered PROSPERO CRD42021220836) to investigate the association between obstructive sleep apnea and incidence of gastrointestinal cancer.
METHODS
We searched four electronic databases (PubMed, Embase, Cochrane Library, Scopus) and included studies published from inception till 15th November 2020 reporting the association of obstructive sleep apnea with gastrointestinal cancer incidence. Extracted data was meta-analyzed in a random-effects model.
RESULTS
A total of seven studies were included, forming a combined cohort of 5,120,837 patients. Studies which adjusted for demographics and comorbidities were included in meta-analysis. Among four studies with 7-11 years of median follow-up, patients with obstructive sleep apnea experienced increased incidence of colorectal cancer (HR 1.70, 95% CI: 1.48-1.96, I=22%). Pancreatic cancer incidence was nominally increased in three studies (HR 1.36, 95% CI: 0.88-2.09, I=96), though this was not statistically significant. There was no association between obstructive sleep apnea and liver cancer incidence among three studies (HR 0.99, 95% CI: 0.81-1.22, I=84). However, the lack of a statistically significant relationship between obstructive sleep apnea and pancreatic cancer in our meta-analysis does not necessarily imply the true absence of an association.
CONCLUSIONS
An increased risk of colorectal cancer was seen in patients with obstructive sleep apnea among studies with long-term follow-up. Further research is required to explore the utility of incorporating obstructive sleep apnea screening into colorectal cancer screening guidelines to identify high-risk individuals and to confirm a possible association of obstructive sleep apnea with pancreatic cancer.
PROSPERO REGISTRATION
CRD42021220836.
背景
新出现的证据表明，阻塞性睡眠呼吸暂停患者的总体癌症发病率较高。包括食管癌、胃癌、肝癌、胰腺癌和结直肠癌在内的胃肠道癌症占新发癌症的26%。然而，胃肠道癌症与阻塞性睡眠呼吸暂停之间的联系仍不清楚。我们进行了一项系统评价和荟萃分析（注册于PROSPERO，注册号CRD42021220836），以研究阻塞性睡眠呼吸暂停与胃肠道癌症发病率之间的关联。
方法
我们检索了四个电子数据库（PubMed、Embase、Cochrane图书馆、Scopus），纳入了从数据库建立至2020年11月15日发表的报告阻塞性睡眠呼吸暂停与胃肠道癌症发病率关联的研究。提取的数据采用随机效应模型进行荟萃分析。
结果
共纳入7项研究，形成了一个包含5120837名患者的合并队列。对人口统计学和合并症进行了调整的研究纳入了荟萃分析。在4项中位随访时间为7至11年的研究中，阻塞性睡眠呼吸暂停患者的结直肠癌发病率增加（风险比1.70，95%置信区间：1.48 - 1.96，I² = 22%）。在3项研究中，胰腺癌发病率名义上有所增加（风险比1.36，95%置信区间：0.88 - 2.09，I² = 96%），但这在统计学上并不显著。在3项研究中，阻塞性睡眠呼吸暂停与肝癌发病率之间没有关联（风险比0.99，95%置信区间：0.81 - 1.22，I² = 84%）。然而，我们的荟萃分析中阻塞性睡眠呼吸暂停与胰腺癌之间缺乏统计学显著关系并不一定意味着两者之间真的不存在关联。
结论
在长期随访的研究中，阻塞性睡眠呼吸暂停患者患结直肠癌的风险增加。需要进一步研究，以探讨将阻塞性睡眠呼吸暂停筛查纳入结直肠癌筛查指南以识别高危个体的实用性，并确认阻塞性睡眠呼吸暂停与胰腺癌之间可能存在的关联。
PROSPERO注册编号：CRD42021220836。
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