Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Brown School, Washington University in St. Louis, St. Louis, Missouri.
Cancer Epidemiol Biomarkers Prev. 2023 Aug 1;32(8):1079-1086. doi: 10.1158/1055-9965.EPI-23-0101.
Risk factors contributing to more than 10-fold increase in esophageal cancer in the last 50 years remain underexplored. We aim to examine the associations of sleep behaviors with esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC).
We prospectively assessed the associations between sleep behaviors (chronotype, duration, daytime napping, daytime sleepiness, snoring, and insomnia) and EAC and ESCC risk in 393,114 participants in the UK Biobank (2006-2016). Participants with 0, 1, and ≥2 unhealthy behaviors, including sleep <6 or >9 h/d, daytime napping, and usual daytime sleepiness were classified as having a good, intermediate, and poor sleep. For EAC, we also examined interactions with polygenic risk score (PRS). Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).
We documented 294 incident EAC and 95 ESCC. Sleep >9 h/d (HR, 2.05; 95% CI, 1.18-3.57) and sometimes daytime napping (HR, 1.36; 95% CI, 1.06-1.75) were individually associated with increased EAC risk. Compared with individuals with good sleep, those with intermediate sleep had a 47% (HR, 1.47; 95% CI, 1.13-1.91) increased EAC risk, and those with poor sleep showed an 87% (HR, 1.87; 95% CI, 1.24-2.82) higher risk (Ptrend < 0.001). The elevated risks for EAC were similar within strata of PRS (Pinteraction = 0.884). Evening chronotype was associated with elevated risk of ESCC diagnosed after 2 years of enrollment (HR, 2.79; 95% CI, 1.32-5.88).
Unhealthy sleep behaviors were associated with an increased risk of EAC, independent of genetic risk.
Sleep behaviors may serve as modifiable factors for the prevention of EAC.
在过去的 50 年中，导致食管癌发病率增加 10 多倍的风险因素仍未得到充分探索。我们旨在研究睡眠行为与食管腺癌（EAC）和鳞状细胞癌（ESCC）的关联。
我们前瞻性评估了 393114 名英国生物库参与者（2006-2016 年）的睡眠行为（时型、持续时间、白天小睡、白天嗜睡、打鼾和失眠）与 EAC 和 ESCC 风险之间的关联。将睡眠<6 或>9 小时/天、白天小睡和习惯性白天嗜睡等 0、1 和≥2 种不健康行为的参与者分为睡眠良好、中等和较差。对于 EAC，我们还检查了与多基因风险评分（PRS）的交互作用。Cox 模型用于估计危险比（HR）和 95%置信区间（CI）。
我们记录了 294 例 EAC 和 95 例 ESCC 事件。睡眠>9 小时/天（HR，2.05；95%CI，1.18-3.57）和有时白天小睡（HR，1.36；95%CI，1.06-1.75）与 EAC 风险增加独立相关。与睡眠良好的个体相比，睡眠中等的个体 EAC 风险增加 47%（HR，1.47；95%CI，1.13-1.91），睡眠差的个体 EAC 风险增加 87%（HR，1.87；95%CI，1.24-2.82）（趋势检验 P<0.001）。在 PRS 分层内，EAC 的风险升高相似（P 交互=0.884）。晚型时型与入组后 2 年诊断的 ESCC 风险升高相关（HR，2.79；95%CI，1.32-5.88）。
不健康的睡眠行为与 EAC 风险增加相关，独立于遗传风险。
睡眠行为可能是预防 EAC 的可改变因素。
