0599 The Association Between Obstructive Sleep Apnea and Cancer Incidence and Mortality: A Systematic Review and Meta-Analysis. (27th May 2020)

• Record Type: Journal Article
• Authors: Sutherland, R; Platt, J
• Is Part Of: Sleep. Volume 43(2020)Supplement 1
• Page Start: A229
• Page End: A229
• Publication Date: 2020-05-27
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsaa056.596
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Sleep related breathing disorders (SRBD) are common (20% prevalence) in the general population and can have multiple health consequences. There is growing evidence that chronic hypoxia - a key consequence of sleep apnea - is a common feature in solid tumour tissue, therapeutic resistance, tumour progression, and metastasis. However, there is conflicting evidence regarding the association between sleep apnea, cancer incidence, or mortality. A review of all available literature and subsequent meta-analysis was done to clarify these relationships. Methods: A thorough literature search was completed using Medline, EMBASE and Web of Science databases. The search resulted in 7222 studies, 1551 duplicates were removed, 5552 studies were removed after abstract screening, and full text review was done on 119 studies, yielding 12 full retrospective cohort studies. The risk of bias was assessed using the Newcastle-Ottawa Scale. Review and data extraction were done in duplicate. Results: In the pooled analysis, 9 studies totalling 2, 358405 subjects with OSA and 3.97% cancer incidence and 2, 442794 subjects without OSA and 3.35% cancer incidence. A random effects model with inverse-variance weighting analysis yielded an unadjusted OR = 1.32 (95% CI: 0.76 - 2.30). After 2 studies with a moderate risk of bias were removed the pooling yielded an OR = 1.89 (95% CI: 0.99 - 3.50). Heterogeneity was high at 99.9% p-value less than 0.01. Meta-regression was then done to assess for the cause(s) of heterogeneity sex, age, or BMI were not significant contributors. A review of 3 studies, which included cancer mortality, was done. Hazard ratios in 2 studies suggested OSA increased the risk of cancer mortality. Hazard ratios also increased with increasing OSA severity. Conclusion: Sleep apnea significantly increases cancer mortality and is positively associated with increasing severity. Meta-analysis demonstrated an 86% increase in the unadjusted odds of cancer in those with sleep apnea. However, this result was borderline non-significant with high heterogeneity. Further studies may be helpful in determining the true associations between sleep apnea and cancer. Support: None.