The relationship between obstructive sleep apnea (OSA) and cancer is unclear.
What is the association between OSA and cancer prevalence and incidence in a large Western Australian (WA) sleep clinic cohort (N=20,289)?
OSA severity was defined by apnea-hypopnea index (AHI) and nocturnal hypoxemia (duration and percentage at SpO<90%) measured by in-laboratory polysomnography. Measures of potential confounding included age, sex, body-mass-index (BMI), smoking, socioeconomic status (SES) and blood pressure. Outcomes were determined from the WA Cancer and Deaths Registries. Analyses were constrained within periods using consistent AHI scoring criteria: 1-January-1989 to 31-July-2002 (American Sleep Disorders Association [ASDA]) and 1-August-2002 to 30-June-2013 (Chicago). We examined associations of AHI and nocturnal hypoxemia with cancer prevalence using logistic regression and cancer incidence using Cox regression analyses.
Cancer prevalence at baseline was 329 of 10,561 in the ASDA period and 633 of 9,728 in the Chicago period. Nocturnal hypoxemia but not AHI was independently associated with prevalent cancer after adjustment for participant age, sex, BMI, smoking, SES and blood pressure.Of those without prevalent cancer, cancer was diagnosed in 1,950 of 10,232 (ASDA) and 623 of 9,095 (Chicago) over a median follow-up of 11.2 years. Compared to the reference category (no OSA: AHI30/h) OSA. Multivariable analyses consistently revealed associations between age and, in some cases, sex, BMI and smoking status, with cancer incidence. After adjusting for confounders, multivariable models demonstrated no independent association between OSA severity and increased cancer incidence.
Nocturnal hypoxemia is independently associated with prevalent cancer. OSA severity is associated with incident cancer but this association appears secondary to other risk factors for cancer development. OSA is not an independent risk factor for cancer incidence.
Copyright © 2023. Published by Elsevier Inc.
