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Obstructive sleep apnea and incident cancer: a large retrospective multicenter clinical cohort study


Background — To examine the association between the severity of obstructive sleep apnea (OSA) and nocturnal hypoxemia with incident cancer.

Methods — A multicenter retrospective clinical cohort study using linked clinical and provincial health administrative data on consecutive adults who underwent a diagnostic sleep study between 1994 and 2017 in four academic hospitals (Canada) who were free of cancer at baseline. Cancer status was derived from the Ontario Cancer Registry. Cox cause-specific regressions were utilized to address the objective and to calculate the 10-year absolute risk difference (ARD) in the marginal probability of incident cancer and the number needed to harm (NNH).

Results — Of 33,997 individuals considered, 33,711 with no missing OSA severity were included: median age 50 years, 58% male, 23% with severe OSA (apnea-hypopnea index >30). Of the 18,458 individuals with information on sleep time spent with oxygen saturation (SaO2) <90%, 5% spent >30% of sleep with SaO2<90% (severe nocturnal hypoxemia). Over a median of 7 years, 2,498/33,711 (7%) of individuals developed cancer with an incidence rate of 10.3 (10.0-10.8) per 1000 person-years. Controlling for confounders, severe OSA was associated with a 15% increased hazard of developing cancer compared to no OSA (HR=1.15; 1.02-1.30; ARD=1.28%; 0.20-2.37; NNH=78). Severe hypoxemia was associated with about 30% increased hazard (HR=1.32; 1.08-1.61; ARD=2.38%; 0.47-4.31; NNH=42).

Conclusions — In a large cohort of individuals with suspected OSA free of cancer at baseline, the severity of OSA and nocturnal hypoxemia were independently associated with incident cancer. 

Impact — Findings suggest the need for more targeted cancer risk awareness in individuals with OSA.



Kendzerska T, Povitz M, Leung RS, Boulos MI, McIsaac DI, Murray BJ, Bryson GL, Talarico R, Hilton JF, Malhotra A, Gershon AS. Cancer Epidemiol Biomarkers Prev. 2021; 30(2):295-304. Epub 2020 Dec 2.

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