Department of Medical Sciences, Lung, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
Centre for Research and Development, Region of Gävleborg Gävle Hospital, Gävle, Sweden.
BMJ Open. 2023 Mar 3;13(3):e064501. doi: 10.1136/bmjopen-2022-064501.
Nocturnal hypoxia in obstructive sleep apnoea (OSA) is a potential risk factor for cancer. We aimed to investigate the association between OSA measures and cancer prevalence in a large national patient cohort.
Cross-sectional study.
44 sleep centres in Sweden.
62 811 patients from the Swedish registry for positive airway pressure (PAP) treatment in OSA, linked to the national cancer registry and national socioeconomic data (the course of DIsease in patients reported to Swedish CPAP, Oxygen and VEntilator RegistrY cohort).
After propensity score matching for relevant confounders (anthropometric data, comorbidities, socioeconomic status, smoking prevalence), sleep apnoea severity, measured as Apnoea-Hypopnoea Index (AHI) or Oxygen Desaturation Index (ODI), were compared between those with and without cancer diagnosis up to 5 years prior to PAP initiation. Subgroup analysis for cancer subtype was performed.
OSA patients with cancer (n=2093) (29.8% females, age 65.3 (SD 10.1) years, body mass index 30 (IQR 27-34) kg/m) had higher median AHI (n/hour) (32 (IQR 20-50) vs 30 (IQR 19-45), n/hour, p=0.002) and median ODI (n/hour) (28 (IQR 17-46) vs 26 (IQR 16-41), p<0.001) when compared with matched OSA patients without cancer. In subgroup analysis, ODI was significantly higher in OSA patients with lung cancer (N=57; 38 (21-61) vs 27 (16-43), p=0.012)), prostate cancer (N=617; 28 (17-46) vs 24, (16-39)p=0.005) and malignant melanoma (N=170; 32 (17-46) vs 25 (14-41),p=0.015).
OSA mediated intermittent hypoxia was independently associated with cancer prevalence in this large, national cohort. Future longitudinal studies are warranted to study the potential protective influence of OSA treatment on cancer incidence.
阻塞性睡眠呼吸暂停（OSA）中的夜间低氧是癌症的潜在危险因素。本研究旨在调查在大型全国患者队列中，OSA 测量指标与癌症患病率之间的关联。
横断面研究。
瑞典 44 个睡眠中心。
来自瑞典正压通气（PAP）治疗睡眠呼吸暂停登记处的 62811 名患者，该登记处与全国癌症登记处和全国社会经济数据（向瑞典 CPAP、氧气和通气登记处报告的患者疾病过程）相关联。
在对相关混杂因素（人体测量数据、合并症、社会经济地位、吸烟流行率）进行倾向评分匹配后，比较 PAP 治疗前 5 年内有和无癌症诊断的患者之间的睡眠呼吸暂停严重程度，以呼吸暂停低通气指数（AHI）或氧减指数（ODI）衡量。对癌症亚型进行了亚组分析。
患有癌症的 OSA 患者（n=2093）（女性占 29.8%，年龄 65.3（SD 10.1）岁，体重指数 30（IQR 27-34）kg/m2）的中位 AHI（小时/数）（32（IQR 20-50）与 30（IQR 19-45），小时/数，p=0.002）和中位 ODI（小时/数）（28（IQR 17-46）与 26（IQR 16-41），p<0.001）高于匹配的无癌症 OSA 患者。在亚组分析中，患有肺癌（n=57）、前列腺癌（n=617）和恶性黑色素瘤（n=170）的 OSA 患者的 ODI 显著升高，分别为（38（21-61）与 27（16-43），p=0.012）、（28（17-46）与 24（16-39），p=0.005）和（32（17-46）与 25（14-41），p=0.015）。
在这个大型的全国性队列中，OSA 介导的间歇性低氧与癌症患病率独立相关。未来的纵向研究需要研究 OSA 治疗对癌症发病率的潜在保护作用。
