Abstract: Rationale: Obstructive sleep apnea (OSA) has been associated with increased cancer mortality, but whether it is also associated with cancer incidence is unknown.
Objectives: To investigate whether OSA is associated with increased cancer incidence in a large clinical cohort.
Methods: A multicenter, clinical cohort study including consecutive patients investigated for suspected OSA between 2003 and 2007 in seven Spanish teaching hospitals. Apnea-hypopnea index (AHI) and percent nighttime with oxygen saturation less than 90% (TSat90) were used as surrogates of OSA severity, both as continuous variables and categorized by tertiles. Cox proportional hazards regression analyses were used to calculate hazard ratio (HR) and 95% confidence interval (CI) for cancer incidence after adjusting for confounding variables.
Measurements and Main Results: A total of 4,910 patients were analyzed (median follow-up, 4.5 yr; interquartile range, 3.4?5.2). Compared with the lower TSat90 category (<1.2%), the adjusted hazards (95% CI) of cancer incidence for increasing categories were 1.58 (1.07?2.34) for TSat90 1.2?12% and 2.33 (1.57?3.46) for TSat90 greater than 12%. Continuous TSat90 was also associated with cancer incidence (adjusted HR, 1.07 [1.02?1.13] per 10-unit increase in TSat90). In stratified analyses, TSat90 was associated with cancer incidence in patients younger than 65 years (adjusted HR, 1.13 [95% CI, 1.06?1.21] per 10-unit increase in TSat90) and males (adjusted HR, 1.11 [95% CI, 1.04?1.17] per 10-unit increase in TSat90). AHI was not associated with cancer incidence in the adjusted analyses, except for patients younger than 65 years (adjusted HR for AHI >43 vs. <18.7, 1.66; 95% CI, 1.04?2.64).
Conclusions: Increased overnight hypoxia as a surrogate of OSA severity was associated with increased cancer incidence. This association seems to be limited to men and patients younger than 65 years of age.
