Srivali Narat, De Giacomi Federica
Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA.
Department of Medicine, Duke University Hospital, Durham, USA.
Sleep Breath. 2025 May 1;29(2):175. doi: 10.1007/s11325-025-03345-9.
Obstructive sleep apnea (OSA) is a prevalent sleep disorder associated with intermittent hypoxia, sleep fragmentation, and systemic inflammation, all of which may influence cancer development. Continuous positive airway pressure (CPAP) therapy is the primary treatment for OSA, yet its impact on cancer risk remains uncertain. We conducted a systematic review and meta-analysis to evaluate the association between CPAP therapy and the incidence of newly diagnosed cancer in patients with OSA.
From inception to March 2025, a comprehensive literature search of MEDLINE, EMBASE, Cochrane databases, and reference lists was conducted. Observational studies assessing the risk of new cancer diagnoses in OSA patients treated with CPAP compared to non-CPAP users were included. Data extraction and quality assessment followed PRISMA guidelines, and meta-analysis was performed using a random-effects model.
Three cohort studies from France, Spain, and Canada, including 72,498 participants, met the inclusion criteria. CPAP compliance varied, defined as > 4 h/night in two studies, while one study lacked specific usage criteria. Cancer diagnoses were ascertained via national registries, hospital databases, or electronic medical records. Meta-analysis revealed a pooled hazard ratio (HR) of 0.81 (95% CI: 0.60-1.09), suggesting a potential reduction in cancer risk among CPAP users. Sensitivity analysis reduced heterogeneity (I² = 0%) and revised the HR to 0.93 (95% CI: 0.81-1.08).
CPAP therapy does not appear to increase cancer risk in OSA patients, but the evidence is limited and inconclusive. Further research, including randomized controlled trials, is needed to confirm these observations and explore underlying mechanisms.
阻塞性睡眠呼吸暂停（OSA）是一种常见的睡眠障碍，与间歇性缺氧、睡眠片段化和全身炎症相关，所有这些都可能影响癌症的发生发展。持续气道正压通气（CPAP）治疗是OSA的主要治疗方法，但其对癌症风险的影响仍不确定。我们进行了一项系统评价和荟萃分析，以评估CPAP治疗与OSA患者新诊断癌症发病率之间的关联。
从研究开始至2025年3月，对MEDLINE、EMBASE、Cochrane数据库及参考文献列表进行了全面的文献检索。纳入了评估接受CPAP治疗的OSA患者与未使用CPAP的患者相比新癌症诊断风险的观察性研究。数据提取和质量评估遵循PRISMA指南，并使用随机效应模型进行荟萃分析。
来自法国、西班牙和加拿大的三项队列研究，共72498名参与者，符合纳入标准。CPAP的依从性各不相同，两项研究将其定义为每晚使用>4小时，而一项研究缺乏具体的使用标准。癌症诊断通过国家登记处、医院数据库或电子病历确定。荟萃分析显示合并风险比（HR）为0.81（95%CI：0.60-1.09），表明CPAP使用者的癌症风险可能降低。敏感性分析降低了异质性（I²=0%），并将HR修订为0.93（95%CI：0.81-1.08）。
CPAP治疗似乎不会增加OSA患者的癌症风险，但证据有限且尚无定论。需要进一步的研究，包括随机对照试验，以证实这些观察结果并探索潜在机制。
