53
|
Gozal D, Farré R, Nieto FJ. Obstructive sleep apnea and cancer: Epidemiologic links and theoretical biological constructs. Sleep Med Rev 2015; 27:43-55. [PMID: 26447849 DOI: 10.1016/j.smrv.2015.05.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/21/2015] [Accepted: 05/25/2015] [Indexed: 12/19/2022]
Abstract
Sleep disorders have emerged as highly prevalent conditions in the last 50-75 y. Along with improved understanding of such disorders, the realization that perturbations in sleep architecture and continuity may initiate, exacerbate or modulate the phenotypic expression of multiple diseases including cancer has gained increased attention. Furthermore, the intermittent hypoxia that is attendant to sleep disordered breathing, has recently been implicated in increased incidence and more adverse prognosis of cancer. The unifying conceptual framework linking these associations proposes that increased sympathetic activity and/or alterations in immune function, particularly affecting innate immune cellular populations, underlie the deleterious effects of sleep disorders on tumor biology. In this review, the epidemiological evidence linking disrupted sleep and intermittent hypoxia to oncological outcomes, and the potential biological underpinnings of such associations as illustrated by experimental murine models will be critically appraised. The overarching conclusion appears supportive in the formulation of an hypothetical framework, in which fragmented sleep and intermittent hypoxia may promote changes in multiple signalosomes and transcription factors that can not only initiate malignant transformation, but will also alter the tumor microenvironment, disrupt immunosurveillance, and thus hasten tumor proliferation and increase local and metastatic invasion. Future bench-based experimental studies as well as carefully conducted and controlled clinical epidemiological studies appear justified for further exploration of these hypotheses.
Collapse
Affiliation(s)
- David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - F Javier Nieto
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| |
Collapse
|
54
|
Moreno-Indias I, Torres M, Montserrat JM, Sanchez-Alcoholado L, Cardona F, Tinahones FJ, Gozal D, Poroyko VA, Navajas D, Queipo-Ortuño MI, Farré R. Intermittent hypoxia alters gut microbiota diversity in a mouse model of sleep apnoea. Eur Respir J 2014; 45:1055-65. [PMID: 25537565 DOI: 10.1183/09031936.00184314] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We assessed whether intermittent hypoxia, which emulates one of the hallmarks of obstructive sleep apnoea (OSA), leads to altered faecal microbiome in a murine model. In vivo partial pressure of oxygen was measured in colonic faeces during intermittent hypoxia in four anesthetised mice. 10 mice were subjected to a pattern of chronic intermittent hypoxia (20 s at 5% O2 and 40 s at room air for 6 h·day(-1)) for 6 weeks and 10 mice served as normoxic controls. Faecal samples were obtained and microbiome composition was determined by 16S rRNA pyrosequencing and bioinformatic analysis by Quantitative Insights into Microbial Ecology. Intermittent hypoxia exposures translated into hypoxia/re-oxygenation patterns in the faeces proximal to the bowel epithelium (<200 μm). A significant effect of intermittent hypoxia on global microbial community structure was found. Intermittent hypoxia increased the α-diversity (Shannon index, p<0.05) and induced a change in the gut microbiota (ANOSIM analysis of β-diversity, p<0.05). Specifically, intermittent hypoxia-exposed mice showed a higher abundance of Firmicutes and a smaller abundance of Bacteroidetes and Proteobacteria phyla than controls. Faecal microbiota composition and diversity are altered as a result of intermittent hypoxia realistically mimicking OSA, suggesting the possibility that physiological interplays between host and gut microbiota could be deregulated in OSA.
Collapse
Affiliation(s)
- Isabel Moreno-Indias
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain. Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBER), Madrid, Spain. These authors contributed equally
| | - Marta Torres
- Laboratori del Son, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBER, Madrid, Spain. These authors contributed equally
| | - Josep M Montserrat
- Laboratori del Son, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBER, Madrid, Spain. Institut Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
| | - Lidia Sanchez-Alcoholado
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain. Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBER), Madrid, Spain
| | - Fernando Cardona
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain. Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBER), Madrid, Spain
| | - Francisco J Tinahones
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain. Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBER), Madrid, Spain
| | - David Gozal
- Section of Pediatric Sleep Medicine, Dept of Pediatrics, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Valeryi A Poroyko
- Section of Pediatric Sleep Medicine, Dept of Pediatrics, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Daniel Navajas
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBER, Madrid, Spain. Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain. Institut Bioenginyeria de Catalunya, Barcelona, Spain
| | - Maria I Queipo-Ortuño
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain. Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBER), Madrid, Spain.
| | - Ramon Farré
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBER, Madrid, Spain. Institut Investigacions Biomediques August Pi Sunyer, Barcelona, Spain. Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain
| |
Collapse
|
55
|
Hirotsu C, Tufik S, Levy Andersen M. Sleep apnea as a potential threat to reproduction. Sleep 2014; 37:1731-2. [PMID: 25364067 DOI: 10.5665/sleep.4158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Camila Hirotsu
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Monica Levy Andersen
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|