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Kader MA, Sainudeen S, Khan AAG, Arora S, Ronsivalle V, Marrapodi MM, Cicciù M, Minervini G. Prevalence of obstructive sleep apnoea syndrome in oncological patients: A systematic review and meta-analysis. J Oral Rehabil 2024; 51:1236-1249. [PMID: 38528326 DOI: 10.1111/joor.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/27/2024] [Accepted: 03/02/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Obstructive sleep apnoea syndrome (OSAS) has garnered increasing attention in recent years due to its potential association with cancer. This systematic review and meta-analysis aimed to assess the prevalence of OSAS in cancer patients through a comprehensive analysis of existing literature. METHODS This systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, aimed to evaluate the prevalence of OSAS in cancer patients. A comprehensive search of electronic databases was performed to identify relevant studies published up to September 2021. Eligible studies reporting on the prevalence of OSAS in cancer patients, encompassing various study designs, were included in the analysis. Pooled estimates of the odds ratios (OR) with 95% confidence intervals (CIs) were calculated using a random effects model. Heterogeneity among the studies was assessed using the I2 statistic. RESULTS Seventeen studies fulfilled the inclusion criteria and were subsequently included in the review. The prevalence of OSAS in cancer patients was estimated to have an overall OR of 0.80 (95% CI: 0.75-0.85). In comparison with non-cancer patients, cancer patients had a statistically significant greater risk of OSAS, as indicated by the total estimated RR for the prevalence of OSAS in cancer patients, which was 0.89 (95% CI: 0.86-0.92). Nonetheless, there was a significant amount of heterogeneity (I2 = 96%) among the studies. CONCLUSION The overall data analysed in this review indicates that patients with cancer had far reduced likelihood of developing OSAS than individuals without cancer. However, the significant variation across the included studies highlights the need for additional investigation to fully clarify the complex association between OSAS and cancer incidence. These results emphasise how critical it is to identify OSAS as a possible comorbidity in cancer patients, one that should be taken into account for clinical management and ongoing research.
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Affiliation(s)
- Mohammed Abdul Kader
- Department of Restorative Dental Science, College of Dentistry, King Khalid University Abha, Abha, Saudi Arabia
| | - Shan Sainudeen
- Department of Restorative Dental Science, College of Dentistry, King Khalid University Abha, Abha, Saudi Arabia
| | - Abdul Ahad Ghaffar Khan
- Department of Oral and Maxillofacial Surgery, King Khalid University College of Dentistry, Abha, Saudi Arabia
| | - Suraj Arora
- Department of Restorative Dental Science, College of Dentistry, King Khalid University Abha, Abha, Saudi Arabia
| | - Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, Largo Madonna delle Grazie 1, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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Cho J, Jo S. Association of obstructive sleep apnea with risk of lung cancer: a nationwide cohort study in Korea. Sci Rep 2024; 14:12394. [PMID: 38811831 PMCID: PMC11137051 DOI: 10.1038/s41598-024-63238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/27/2024] [Indexed: 05/31/2024] Open
Abstract
Current knowledge regarding the relationship between obstructive sleep apnea (OSA) and the risk of lung cancer is limited. This study aimed to evaluate associations between OSA and the incidence of lung cancer based on the Korean National Health Information Database. The study outcome was the incidence of newly diagnosed lung cancer, and a Cox proportional hazards model was used for analysis. A total of 181,070 adult patients newly diagnosed with OSA between 2011 and 2018 were matched with those without OSA by up to 1:5 propensity score matching based on age and sex. During follow-up over (mean ± standard deviation) 9.1 ± 2.0 years, 2614 incident cases of lung cancer were identified. The incidence rate was 39.51 per 100,000 person-years in the OSA group, and 24.93 per 100,000 person-years in the control group. After adjusting for income and the presence of comorbidities, the association remained significant (hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.74-2.18, p-value < 0.001). The adjusted HR for incident lung cancer was 2.14 (95% CI 1.69-2.70) in female patients with OSA, and 1.90 (95% CI 1.67-2.16) in male patients with OSA. The risk of incident lung cancer increased with age, with a HR of 2.99 (95% CI 2.46-3.64) in those aged ≥ 65 years. This nationwide study showed an independent association between OSA and an increased risk of lung cancer in the Korean population.
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Affiliation(s)
- Jaeyoung Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Soomin Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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Burch JB, Delage AF, Zhang H, McLain AC, Ray MA, Miller A, Adams SA, Hébert JR. Sleep disorders and cancer incidence: examining duration and severity of diagnosis among veterans. Front Oncol 2024; 14:1336487. [PMID: 38469244 PMCID: PMC10927008 DOI: 10.3389/fonc.2024.1336487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Sleep disruption affects biological processes that facilitate carcinogenesis. This retrospective cohort study used de-identified data from the Veterans Administration (VA) electronic medical record system to test the hypothesis that patients with diagnosed sleep disorders had an increased risk of prostate, breast, colorectal, or other cancers (1999-2010, N=663,869). This study builds upon existing evidence by examining whether patients with more severe or longer-duration diagnoses were at a greater risk of these cancers relative to those with a less severe or shorter duration sleep disorder. Methods Incident cancer cases were identified in the VA Tumor Registry and sleep disorders were defined by International Classification of Sleep Disorder codes. Analyses were performed using extended Cox regression with sleep disorder diagnosis as a time-varying covariate. Results Sleep disorders were present among 56,055 eligible patients (8% of the study population); sleep apnea (46%) and insomnia (40%) were the most common diagnoses. There were 18,181 cancer diagnoses (41% prostate, 12% colorectal, 1% female breast, 46% other). The hazard ratio (HR) for a cancer diagnosis was 1.45 (95% confidence interval [CI]: 1.37, 1.54) among those with any sleep disorder, after adjustment for age, sex, state of residence, and marital status. Risks increased with increasing sleep disorder duration (short [<1-2 years] HR: 1.04 [CI: 1.03-1.06], medium [>2-5 years] 1.23 [1.16-1.32]; long [>5-12 years] 1.52 [1.34-1.73]). Risks also increased with increasing sleep disorder severity using cumulative sleep disorder treatments as a surrogate exposure; African Americans with more severe disorders had greater risks relative to those with fewer treatments and other race groups. Results among patients with only sleep apnea, insomnia, or another sleep disorder were similar to those for all sleep disorders combined. Discussion The findings are consistent with other studies indicating that sleep disruption is a cancer risk factor. Optimal sleep and appropriate sleep disorder management are modifiable risk factors that may facilitate cancer prevention.
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Affiliation(s)
- James B. Burch
- Department of Epidemiology, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Alexandria F. Delage
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Palmetto GBA, Columbia, SC, United States
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Alexander C. McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Meredith A. Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Austin Miller
- Alabama College of Osteopathic Medicine, Dothan, AL, United States
| | - Swann A. Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, United States
| | - James R. Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- South Carolina Statewide Cancer Prevention & Control Program, University of South Carolina, Columbia, SC, United States
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Pluchart H, Chanoine S, Moro-Sibilot D, Chouaid C, Frey G, Villa J, Degano B, Giaj Levra M, Bedouch P, Toffart AC. Lung cancer, comorbidities, and medication: the infernal trio. Front Pharmacol 2024; 14:1016976. [PMID: 38450055 PMCID: PMC10916800 DOI: 10.3389/fphar.2023.1016976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/25/2023] [Indexed: 03/08/2024] Open
Abstract
Most patients with lung cancer are smokers and are of advanced age. They are therefore at high risk of having age- and lifestyle-related comorbidities. These comorbidities are subject to treatment or even polypharmacy. There is growing evidence of a link between lung cancer, comorbidities and medications. The relationships between these entities are complex. The presence of comorbidities and their treatments influence the time of cancer diagnosis, as well as the diagnostic and treatment strategy. On the other hand, cancer treatment may have an impact on the patient's comorbidities such as renal failure, pneumonitis or endocrinopathies. This review highlights how some comorbidities may have an impact on lung cancer presentation and may require treatment adjustments. Reciprocal influences between the treatment of comorbidities and anticancer therapy will also be discussed.
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Affiliation(s)
- Hélène Pluchart
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC UMR5525, Grenoble, France
| | - Sébastien Chanoine
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
| | - Denis Moro-Sibilot
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Inserm U955, UPEC, IMRB, équipe CEpiA, CréteilFrance
| | - Gil Frey
- Service de Chirurgie Thoracique, Vasculaire et Endocrinienne, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Julie Villa
- Service de Radiothérapie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- Université Grenoble Alpes, Grenoble, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Grenoble, France
| | - Matteo Giaj Levra
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Pierrick Bedouch
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC UMR5525, Grenoble, France
| | - Anne-Claire Toffart
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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Gómez-Olivas JD, Campos-Rodriguez F, Nagore E, Martorell A, García-Rio F, Cubillos C, Hernandez L, Bañuls J, Arias E, Ortiz P, Cabriada V, Gardeazabal J, Montserrat JM, Carrera C, Masa JF, Gomez de Terreros J, Abad J, Boada A, Mediano O, Castillo-Garcia M, Chiner E, Landete P, Mayos M, Fortuna A, Barbé F, Sanchez-de-la-Torre M, Cano-Pumarega I, Perez-Gil A, Gomez-Garcia T, Cullen D, Somoza M, Formigon M, Aizpuru F, Oscullo G, Garcia-Ortega A, Almendros I, Farré R, Gozal D, Martinez-Garcia MA. Role of Sleep Apnea and Long-Term CPAP Treatment in the Prognosis of Patients With Melanoma: A Prospective Multicenter Study of 443 Patients. Chest 2023; 164:1551-1559. [PMID: 37348828 DOI: 10.1016/j.chest.2023.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 05/20/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND OSA has been associated with increased incidence and aggressiveness of melanoma. However, the long-term impact of OSA and CPAP treatment on the prognosis of melanoma remains unexplored. RESEARCH QUESTION Are OSA and CPAP treatment associated independently with a poor prognosis for cutaneous melanoma? STUDY DESIGN AND METHODS Four hundred forty-three patients with a diagnosis of cutaneous melanoma (2012-2015) underwent a sleep study within 6 months of diagnosis. The main 5-year outcome of the study was a composite of melanoma recurrence, metastasis, or mortality. Patients were divided into four groups: baseline apnea-hypopnea index (AHI) of fewer than 10 events/h (no OSA; control group), OSA treated with CPAP and good adherence, untreated or poor CPAP adherence in moderate (AHI, 10-29 events/h), and severe OSA (AHI, ≥ 30 events/h). Survival analysis was used to determine the independent role of OSA and CPAP treatment on melanoma composite outcome. RESULTS Three hundred ninety-one patients (88.2%) were available for analysis at 5-year follow-up (mean age, 65.1 ± 15.2 years; 49% male; Breslow index, 1.7 ± 2.5 mm). One hundred thirty-nine patients had AHI of fewer than 10 events/h (control group); 78 patients with OSA were adherent to CPAP; and 124 and 50 patients had moderate and severe OSA, respectively, without CPAP treatment. Median follow-up was 60 months (interquartile range, 51-74 months). During follow-up, 32 relapses, 53 metastases, and 52 deaths occurred (116 patients showed at least one of the main composite outcomes). After adjusting for age, sex, sentinel lymph nodes affected at diagnosis, BMI, diabetes, nighttime with an oxygen saturation below 90%, Breslow index, Epworth sleepiness scale scores, and melanoma treatment, moderate (hazard ratio [HR], 2.45; 95% CI, 1.09-5.49) and severe OSA (HR, 2.96; 95% CI, 1.36-6.42) were associated with poorer prognosis of melanoma compared with the control group. However, good adherence to CPAP avoided this excess risk (HR, 1.66; 95% CI, 0.71-3.90). INTERPRETATION Moderate to severe untreated OSA is an independent risk factor for poor prognosis of melanoma. Treatment with CPAP is associated with improved melanoma outcomes compared with untreated moderate to severe OSA.
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Affiliation(s)
- Jose Daniel Gómez-Olivas
- Respiratory Department, Hospital Universitario y Politecnico la Fe, Hospital de Manises, Valencia, Spain
| | - Francisco Campos-Rodriguez
- Respiratory Department, Instituto Andaluz de Investigación, Seville, Spain; Hospital Valme, IBIS, Instituto Andaluz de Investigación, Seville, Spain; CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Eduardo Nagore
- Dermatology Department, Instituto Valenciano de Oncologia, Hospital de Manises, Valencia, Spain
| | | | - Francisco García-Rio
- Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Carolina Cubillos
- Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Luis Hernandez
- Respiratory Department, Hospital General Universitario Balmis de Alicante, UMH, Spain; Clinical Medicine Department, UMH, Spain
| | - Jose Bañuls
- Dermatology Department, Hospital General Universitario Balmis de Alicante, UMH, Spain; Clinical Medicine Department, UMH, Spain
| | - Eva Arias
- Respiratory Department, Hospital Universitario 12 de Octubre, Spain
| | - Pablo Ortiz
- Dermatology Department, Hospital Universitario 12 de Octubre, Spain
| | - Valentin Cabriada
- Respiratory Department, Hospital Universitario Cruces, Barakaldo, Spain
| | - Juan Gardeazabal
- Dermatology Department, Hospital Universitario Cruces, Barakaldo, Spain
| | - Josep Maria Montserrat
- CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain; Respiratory Department, Hospital Clinic-IDIBAPS, Spain
| | | | - Juan Fernando Masa
- CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain; Respiratory Department, Hospital Universitario San Pedro de Alcantara, Caceres, Spain
| | - Javier Gomez de Terreros
- CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain; Respiratory Department, Hospital Universitario San Pedro de Alcantara, Caceres, Spain
| | - Jorge Abad
- Respiratory Department, Hospital Universitario Germans Trials I Pujol, Spain
| | - Adam Boada
- Dermatology Department, Hospital Universitario Germans Trials I Pujol, Spain
| | - Olga Mediano
- CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain; Respiratory Department, Hospital Universitario General de Guadalajara, Guadalajara, Spain
| | - Marta Castillo-Garcia
- Respiratory Department, Hospital Universitario General de Guadalajara, Guadalajara, Spain
| | - Eusebi Chiner
- Respiratory Department, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Pedro Landete
- Respiratory Department, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Mercedes Mayos
- Respiratory Department, Hospital Universitario Santa Creu i Sant Pau, Spain
| | - Ana Fortuna
- CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain; Respiratory Department, Hospital Universitario Santa Creu i Sant Pau, Spain
| | - Ferrán Barbé
- CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain; Group of Precision Medicine in Chronic Diseases, Respiratory Department, University Hospital Arnau de Vilanova and Santa María, Spain; Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida. IRBLleida, Lleida, Spain
| | - Manuel Sanchez-de-la-Torre
- CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain; Group of Precision Medicine in Chronic Diseases, Respiratory Department, University Hospital Arnau de Vilanova and Santa María, Spain; Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida. IRBLleida, Lleida, Spain
| | | | - Amalia Perez-Gil
- Dermatology Department, Instituto Andaluz de Investigación, Seville, Spain
| | - Teresa Gomez-Garcia
- Respiratory Department, Fundacion Jimenez Diaz, Madrid, Spain; CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Daniela Cullen
- Dermatology Department, Fundacion Jimenez Diaz, Madrid, Spain
| | - Maria Somoza
- Respiratory Department, Consorcio Sanitario Terrassa, Spain
| | | | - Felipe Aizpuru
- Biostatistical Service, BioAraba, Health Research Institute, OSI Araba University Hospital, Basque Health Service, University of the Basque Country, Leioa, Spain
| | - Grace Oscullo
- Respiratory Department, Hospital Universitario y Politecnico la Fe, Hospital de Manises, Valencia, Spain
| | - Alberto Garcia-Ortega
- Respiratory Department, Hospital Universitario y Politecnico la Fe, Hospital de Manises, Valencia, Spain
| | - Isaac Almendros
- Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain; CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain; Unitat de Biofisica i Bioenginyeria, Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Ramón Farré
- Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain; CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain; Unitat de Biofisica i Bioenginyeria, Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - David Gozal
- Department of Child Health and Child Health Research Institute, School of Medicine, The University of Missouri, Columbia, MO
| | - Miguel Angel Martinez-Garcia
- Respiratory Department, Hospital Universitario y Politecnico la Fe, Hospital de Manises, Valencia, Spain; CIBERes, VCIBER de Enfermedades Respiratorias, Madrid, Spain.
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Tondo P, Scioscia G, Sabato R, Leccisotti R, Hoxhallari A, Sorangelo S, Mansueto G, Campanino T, Carone M, Foschino Barbaro MP, Lacedonia D. Mortality in obstructive sleep apnea syndrome (OSAS) and overlap syndrome (OS): The role of nocturnal hypoxemia and CPAP compliance. Sleep Med 2023; 112:96-103. [PMID: 37837825 DOI: 10.1016/j.sleep.2023.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are two chronic diseases that afflict many individuals worldwide with negative effects on health that may overlap in Overlap Syndrome (OS). The aim of our study was to investigate the differences in mortality between OSAS alone and OS and the risk factors involved. METHODS The study was conducted on patients with OSAS or OS diagnosis that completed 15-year follow-up between 2005 and 2023. Of these, the clinical, functional, sleep and survival data were registered and analysed. Risk factors were found by regression analysis. RESULTS 501 patients (428 OSAS and 73 OS) were enrolled. Patients with OS had higher mortality than OSAS (p < 0,001). The morality risk factors for the overall population found were age >65 years (odds ratio (OR) = 10.69 (95%CI 3,85-29,69), p < 0,001) and low forced-expiratory volume in 1-s (FEV1) (OR = 10.18 (95%CI 2,32-44,68), p = 0,002). In patients with OSAS, age and nocturnal hypoxemia (NH) (OR = 2.41 (95%CI 1,07-5,41), p = 0,03) were risk factors, while adherence to nighttime positive airway pressure (PAP) reduced mortality (OR = 0,36 (95%CI 0,15-0,83), p = 0,017). Multivariate analysis confirmed age and FEV1 as risk factors in OS. Conversely, the risk factors for the overall population under 65 years were NH, which is confirmed in patients with OSAS alone (OR = 4,72 (95%CI 1,07-20,77), p = 0,04) in whom, on the other hand, PAP compliance reduced the mortality risk. CONCLUSIONS The study suggests that NH is a risk factor for all-cause mortality in sleep disorders by excluding the age; conversely, nighttime PAP improves the survival.
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Affiliation(s)
- Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Medicine, Department of Specialistic Medicine, University-Hospital Policlinico of Foggia, Foggia, Italy.
| | - Roberto Sabato
- Institute of Respiratory Medicine, Department of Specialistic Medicine, University-Hospital Policlinico of Foggia, Foggia, Italy.
| | - Rosa Leccisotti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Medicine, Department of Specialistic Medicine, University-Hospital Policlinico of Foggia, Foggia, Italy.
| | - Anela Hoxhallari
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Medicine, Department of Specialistic Medicine, University-Hospital Policlinico of Foggia, Foggia, Italy.
| | - Simone Sorangelo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Medicine, Department of Specialistic Medicine, University-Hospital Policlinico of Foggia, Foggia, Italy.
| | - Giuseppe Mansueto
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Medicine, Department of Specialistic Medicine, University-Hospital Policlinico of Foggia, Foggia, Italy.
| | - Terence Campanino
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Medicine, Department of Specialistic Medicine, University-Hospital Policlinico of Foggia, Foggia, Italy.
| | - Mauro Carone
- Division of Pulmonary Disease and Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS Bari Institute, Bari, Italy.
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Medicine, Department of Specialistic Medicine, University-Hospital Policlinico of Foggia, Foggia, Italy.
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Institute of Respiratory Medicine, Department of Specialistic Medicine, University-Hospital Policlinico of Foggia, Foggia, Italy.
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Balachandran DD, Bashoura L, Sheshadri A, Manzullo E, Faiz SA. The Impact of Immunotherapy on Sleep and Circadian Rhythms in Patients with Cancer. Front Oncol 2023; 13:1295267. [PMID: 38090501 PMCID: PMC10711041 DOI: 10.3389/fonc.2023.1295267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/06/2023] [Indexed: 02/01/2024] Open
Abstract
Immunotherapy has revolutionized treatments for both early and advanced cancers, and as their role evolves, their impact on sleep and circadian rhythms continues to unfold. The recognition, evaluation, and treatment of sleep and circadian rhythm disturbance leads to improved symptom management, quality of life and treatment outcomes. An intricate complex relationship exists in the microenvironment with immunity, sleep and the tumor, and these may further vary based on the cancer, addition of standard chemotherapy, and pre-existing patient factors. Sleep and circadian rhythms may offer tools to better utilize immunotherapy in the care of cancer patients, leading to better treatment outcome, reduced symptom burden, and increased quality of life.
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Affiliation(s)
- Diwakar D. Balachandran
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lara Bashoura
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ellen Manzullo
- Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saadia A. Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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8
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Liao J, Gao X, Shi Y, Li Y, Han D. Evaluation of obstructive sleep apnea: an analysis based on aberrant genes. Sleep Breath 2023; 27:1419-1431. [PMID: 36418734 DOI: 10.1007/s11325-022-02749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is an upstream disorder that frequently causes multisystem disorders. Much research has revealed the pathogenesis of OSA, but there is still a lack of research on the complications caused by OSA. METHODS The mRNA expression and methylation dataset based on peripheral blood mononuclear cells (PBMCs) were downloaded from the Gene Expression Omnibus (GEO) database. All differential expressed genes (DEGs) were ranked using the Robust Rank Aggregation (RRA) algorithm. A weighted gene co-expression network analysis (WGCNA) was constructed. Subsequently, we used immune infiltration, enrichment analysis, and least absolute shrinkage and selection operator (LASSO) regression analysis for apnea and hypopnea index (AHI) and hypertension and excessive daytime sleepiness (EDS) and constructed diagnostic model using random forest algorithm. RESULTS In the present study, we identified 318 DEGs in PBMCs involved in pathogenesis or continuous positive airway pressure (CPAP) therapy. Pathway enrichment identified DEGs associated with protein regulation and metabolism. Notably, through intra group analysis, we found that the immune disorder was more significant for OSA in males, non-daytime sleepy, or non-hypertensive OSA. The area under the ROC curve of model for EDS prediction is 0.889 and 0.852 for hypertension. Notably, we found that the diagnostic model had a high linear predictive value for AHI. CONCLUSIONS Our results indicate that PBMCs are a significant component of alterations in OSA and are expected to explain the mechanism of multisystem diseases caused by OSA. The present study provides new insights for symptom evaluation, classification and treatment of OSA from the molecular level.
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Affiliation(s)
- Jianhong Liao
- The Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, 100730, China
| | - Xiang Gao
- The Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, 100730, China
| | - Yunhan Shi
- The Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, 100730, China
| | - Yanru Li
- The Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, 100730, China.
| | - Demin Han
- The Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
- Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, 100730, China.
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9
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Zhuravlev M, Agaltsov M, Kiselev A, Simonyan M, Novikov M, Selskii A, Ukolov R, Drapkina O, Orlova A, Penzel T, Runnova A. Compensatory mechanisms of reduced interhemispheric EEG connectivity during sleep in patients with apnea. Sci Rep 2023; 13:8444. [PMID: 37231107 PMCID: PMC10213009 DOI: 10.1038/s41598-023-35376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
We performed a mathematical analysis of functional connectivity in electroencephalography (EEG) of patients with obstructive sleep apnea (OSA) (N = 10; age: 52.8 ± 13 years; median age: 49 years; male/female ratio: 7/3), compared with a group of apparently healthy participants (N = 15; age: 51.5 ± 29.5 years; median age: 42 years; male/female ratio: 8/7), based on the calculation of wavelet bicoherence from nighttime polysomnograms. Having observed the previously known phenomenon of interhemispheric synchronization deterioration, we demonstrated a compensatory increase in intrahemispheric connectivity, as well as a slight increase in the connectivity of the central and occipital areas for high-frequency EEG activity. Significant changes in functional connectivity were extremely stable in groups of apparently healthy participants and OSA patients, maintaining the overall pattern when comparing different recording nights and various sleep stages. The maximum variability of the connectivity was observed at fast oscillatory processes during REM sleep. The possibility of observing some changes in functional connectivity of brain activity in OSA patients in a state of passive wakefulness opens up prospects for further research. Developing the methods of hypnogram evaluation that are independent of functional connectivity may be useful for implementing a medical decision support system.
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Affiliation(s)
- Maksim Zhuravlev
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
- Institute of Physics, Saratov State University, Saratov, Russia
| | - Mikhail Agaltsov
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Anton Kiselev
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Margarita Simonyan
- Institute of Physics, Saratov State University, Saratov, Russia
- Institute of Cardiology Research, Saratov State Medical University, Saratov, Russia
| | - Mikhail Novikov
- Institute of Cardiology Research, Saratov State Medical University, Saratov, Russia
| | - Anton Selskii
- Institute of Physics, Saratov State University, Saratov, Russia
| | - Rodion Ukolov
- Institute of Physics, Saratov State University, Saratov, Russia
| | - Oksana Drapkina
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Anna Orlova
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anastasiya Runnova
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia.
- Institute of Physics, Saratov State University, Saratov, Russia.
- Institute of Cardiology Research, Saratov State Medical University, Saratov, Russia.
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Minoves M, Hazane-Puch F, Moriondo G, Boutin-Paradis A, Lemarié E, Pépin JL, Godin-Ribuot D, Briançon-Marjollet A. Differential Impact of Intermittent vs. Sustained Hypoxia on HIF-1, VEGF and Proliferation of HepG2 Cells. Int J Mol Sci 2023; 24:ijms24086875. [PMID: 37108039 PMCID: PMC10139223 DOI: 10.3390/ijms24086875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
Obstructive sleep apnea (OSA) is an emerging risk factor for cancer occurrence and progression, mainly mediated by intermittent hypoxia (IH). Systemic IH, a main landmark of OSA, and local sustained hypoxia (SH), a classical feature at the core of tumors, may act separately or synergistically on tumor cells. Our aim was to compare the respective consequences of intermittent and sustained hypoxia on HIF-1, endothelin-1 and VEGF expression and on cell proliferation and migration in HepG2 liver tumor cells. Wound healing, spheroid expansion, proliferation and migration were evaluated in HepG2 cells following IH or SH exposure. The HIF-1α, endothelin-1 and VEGF protein levels and/or mRNA expression were assessed, as were the effects of HIF-1 (acriflavine), endothelin-1 (macitentan) and VEGF (pazopanib) inhibition. Both SH and IH stimulated wound healing, spheroid expansion and proliferation of HepG2 cells. HIF-1 and VEGF, but not endothelin-1, expression increased with IH exposure but not with SH exposure. Acriflavine prevented the effects of both IH and SH, and pazopanib blocked those of IH but not those of SH. Macitentan had no impact. Thus, IH and SH stimulate hepatic cancer cell proliferation via distinct signaling pathways that may act synergistically in OSA patients with cancer, leading to enhanced tumor progression.
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Affiliation(s)
- Mélanie Minoves
- INSERM U1300, HP2 Laboratory, CHU Grenoble Alpes, University Grenoble Alpes, 38042 Grenoble, France
| | | | - Giorgia Moriondo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Antoine Boutin-Paradis
- INSERM U1300, HP2 Laboratory, CHU Grenoble Alpes, University Grenoble Alpes, 38042 Grenoble, France
| | - Emeline Lemarié
- INSERM U1300, HP2 Laboratory, CHU Grenoble Alpes, University Grenoble Alpes, 38042 Grenoble, France
| | - Jean-Louis Pépin
- INSERM U1300, HP2 Laboratory, CHU Grenoble Alpes, University Grenoble Alpes, 38042 Grenoble, France
| | - Diane Godin-Ribuot
- INSERM U1300, HP2 Laboratory, CHU Grenoble Alpes, University Grenoble Alpes, 38042 Grenoble, France
| | - Anne Briançon-Marjollet
- INSERM U1300, HP2 Laboratory, CHU Grenoble Alpes, University Grenoble Alpes, 38042 Grenoble, France
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11
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Palm A, Theorell-Haglöw J, Isakson J, Ljunggren M, Sundh J, Ekström MP, Grote L. Association between obstructive sleep apnoea and cancer: a cross-sectional, population-based study of the DISCOVERY cohort. BMJ Open 2023; 13:e064501. [PMID: 36868588 PMCID: PMC9990651 DOI: 10.1136/bmjopen-2022-064501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES Nocturnal hypoxia in obstructive sleep apnoea (OSA) is a potential risk factor for cancer. We aimed to investigate the association between OSA measures and cancer prevalence in a large national patient cohort. DESIGN Cross-sectional study. SETTINGS 44 sleep centres in Sweden. PARTICIPANTS 62 811 patients from the Swedish registry for positive airway pressure (PAP) treatment in OSA, linked to the national cancer registry and national socioeconomic data (the course of DIsease in patients reported to Swedish CPAP, Oxygen and VEntilator RegistrY cohort). OUTCOME MEASURES After propensity score matching for relevant confounders (anthropometric data, comorbidities, socioeconomic status, smoking prevalence), sleep apnoea severity, measured as Apnoea-Hypopnoea Index (AHI) or Oxygen Desaturation Index (ODI), were compared between those with and without cancer diagnosis up to 5 years prior to PAP initiation. Subgroup analysis for cancer subtype was performed. RESULTS OSA patients with cancer (n=2093) (29.8% females, age 65.3 (SD 10.1) years, body mass index 30 (IQR 27-34) kg/m2) had higher median AHI (n/hour) (32 (IQR 20-50) vs 30 (IQR 19-45), n/hour, p=0.002) and median ODI (n/hour) (28 (IQR 17-46) vs 26 (IQR 16-41), p<0.001) when compared with matched OSA patients without cancer. In subgroup analysis, ODI was significantly higher in OSA patients with lung cancer (N=57; 38 (21-61) vs 27 (16-43), p=0.012)), prostate cancer (N=617; 28 (17-46) vs 24, (16-39)p=0.005) and malignant melanoma (N=170; 32 (17-46) vs 25 (14-41),p=0.015). CONCLUSIONS OSA mediated intermittent hypoxia was independently associated with cancer prevalence in this large, national cohort. Future longitudinal studies are warranted to study the potential protective influence of OSA treatment on cancer incidence.
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Affiliation(s)
- Andreas Palm
- Department of Medical Sciences, Lung, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Region of Gävleborg Gävle Hospital, Gävle, Sweden
| | - J Theorell-Haglöw
- Department of Medical Sciences, Lung, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Johan Isakson
- Centre for Research and Development, Region of Gävleborg, Gävle Hospital, Gävle, Sweden
| | - Mirjam Ljunggren
- Department of Medical Sciences, Lung, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Magnus Per Ekström
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Lund University, Lund, Sweden, Lund, Sweden
| | - Ludger Grote
- Sahlgrenska Academy, Gothenburg University, Centre for Sleep and Wake Disorders, Goteborg, Sweden
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12
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Bade BC, Faiz SA, Ha DM, Tan M, Barton-Burke M, Cheville AL, Escalante CP, Gozal D, Granger CL, Presley CJ, Smith SM, Chamberlaine DM, Long JM, Malone DJ, Pirl WF, Robinson HL, Yasufuku K, Rivera MP. Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e6-e28. [PMID: 36856560 PMCID: PMC10870898 DOI: 10.1164/rccm.202210-1963st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel's initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors.
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13
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Association between obstructive sleep apnea and floppy eyelid syndrome: A systematic review and metaanalysis. Surv Ophthalmol 2023; 68:257-264. [PMID: 36427560 DOI: 10.1016/j.survophthal.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
RATIONALE Obstructive sleep apnoea (OSA) has been linked to various ocular disorders, including floppy eyelid syndrome (FES). Previous studies have hypothesised the underlying association between the 2 , but results are currently still inconclusive. OBJECTIVE To investigate the association between OSA and FES. METHODS Four databases (Pubmed, Embase, Scopus, and Cochrane Library) were searched from inception until 28 February 2022 for observational studies and randomized controlled trials assessing the association between OSA and FES. Two reviewers selected studies, extracted data, graded the risk of bias using the Newcastle-Ottawa scale and the quality of assessment using the Grading of Recommendations Assessment, Development, and Evaluation system. Random-effects models were used to metaanalyze the associations. RESULTS Twelve studies were included in the systematic review, of which nine were suitable for metaanalysis, with a combined cohort of 1,109 patients. Risk of bias was low to moderate. The overall analysis showed a significant positive association between OSA and FES (OR = 1.89, 95% CI = 1.27-2.83, I 2 = 44%). Further analysis revealed that the more severe the OSA was, the higher the risk of developing FES. Patients with severe OSA had the nominally highest risk of developing FES (OR = 3.06, 95% CI = 1.62-5.78, I 2 = 0%), followed by moderate OSA (OR = 2.53, 95% CI = 1.29-4.97, I 2 = 0%), and patients with mild OSA had the lowest risk (OR = 1.76, 95% CI = 0.85-3.62, I 2 = 0%). CONCLUSION Our metaanalysis reports a positive association between OSA and FES, with increasing severity of OSA correlating with a significantly higher risk of FES. More longitudinal studies with sufficient duration of follow-up are needed to better characterise the relationship between OSA and FES.
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14
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Scher N, Guetta L, Draghi C, Yahiaoui S, Terzioglu M, Butaye E, Henriques K, Alavoine M, Elharar A, Guetta A, Toledano A. Sleep Disorders and Quality of Life in Patients With Cancer: Prospective Observational Study of the Rafael Institute. JMIR Form Res 2022; 6:e37371. [PMID: 36422866 PMCID: PMC9732755 DOI: 10.2196/37371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/22/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sleep disorders are a common occurrence in the general population. Yet today, it is clearly agreed that sleep disorders represent both a cancer risk factor and a biological consequence of the of the activation of the immuno-inflammatory system induced by cancer itself. OBJECTIVE The aim of this study was to assess the impact of sleep disorders on quality of life and identify the type of disorder and its causes in order to offer an adapted and personalized care plan. METHODS In a survey completed during the COVID-19 lockdown, 2000 hours of interviews were collected by remote consultations. During these calls, we administered a sleep questionnaire. This questionnaire was inspired by the STOP-BANG questionnaire and enquired about 6 items. The demographic details of each patient (eg, age and sex), the nature of the pathology, their past treatments, the ongoing cancer treatment, the mood, whether or not the patient is anxious or depressed, and the use of sleeping drug pills were analyzed. A univariate analysis was performed according to the presence or absence of fatigue. Chi-square test was applied to assess possible differences of variables' link to sleep disturbance between patients complaining of fatigue and those without fatigue. The same test was then used to analyze patients on hormone therapy and those with no hormone therapy for 2 types of cancer-breast cancer and prostate cancer. RESULTS A total of 905 patients were prospectively included in this study. The average age was 66.7 (5 SD) years, and 606 (67%) patients were women; 142 patients declared being overweight. Breast cancer was the most frequently reported cancer. Nocturnal awakening was reported by 70% (n=633), fatigue by 50% (n=452), difficulty falling asleep by 38% (n=343), snoring reported by an independent observer in 38% (n=343), and apnea reported by an independent observer in 9% (n=81) of the patients. The univariate analysis showed that the feeling of tiredness was significantly greater in patients reporting difficulty falling asleep (P≥.99), pain (P<.001), and frequent awakening (P<.001), as well as in patients who were not receiving cancer treatment (P<.001). The univariate analysis showed that patients who were receiving breast cancer treatment and were under hormone therapy reported difficulty falling asleep (P=.04) and pain (P=.05). In a univariate analysis of patients treated for prostate cancer, being overweight was the only factor reported that had a statistically significant value. CONCLUSIONS Our preliminary data support and are consistent with data in the literature regarding the importance of sleep disorders in oncology. This justifies the usefulness of a diagnosis and early treatment of sleep disorders in patients with cancer. The Rafael Institute sleep observatory will enable patients to be identified and treated.
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Affiliation(s)
- Nathaniel Scher
- Integrative Medicine, Rafael Institute, Levallois-Perret, France
- Hartmann Oncology Radiotherapy Group, Hartmann Radiotherapy Institute, Levallois Perret, France
| | - Liath Guetta
- Integrative Medicine, Rafael Institute, Levallois-Perret, France
| | - Clément Draghi
- Integrative Medicine, Rafael Institute, Levallois-Perret, France
| | - Safia Yahiaoui
- Integrative Medicine, Rafael Institute, Levallois-Perret, France
- Department of Radiotherapy, Institut Salah Azaiz, Tunis, Tunisia
| | | | - Emilie Butaye
- Integrative Medicine, Rafael Institute, Levallois-Perret, France
| | - Kathy Henriques
- Integrative Medicine, Rafael Institute, Levallois-Perret, France
| | - Marie Alavoine
- Integrative Medicine, Rafael Institute, Levallois-Perret, France
| | - Ayala Elharar
- Integrative Medicine, Rafael Institute, Levallois-Perret, France
| | - Andre Guetta
- Integrative Medicine, Rafael Institute, Levallois-Perret, France
| | - Alain Toledano
- Integrative Medicine, Rafael Institute, Levallois-Perret, France
- Department of Integrative Medicine, National Conservatory of Arts and Crafts, Paris, France
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Tan BKJ, Tan NKW, Teo YH, Yap DWT, Raghupathy J, Gao EY, Toh ST, See A. Association of obstructive sleep apnea with thyroid cancer incidence: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:5407-5414. [PMID: 35708764 DOI: 10.1007/s00405-022-07457-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a postulated carcinogen based on epidemiological associations with all-cancer incidence and non-thyroid biological models. However, associations with thyroid carcinoma are unclear. METHODS We included observational/randomized studies of associations of OSA with thyroid carcinoma incidence/mortality in adults, from four databases. Random-effects meta-analyses and the population attributable fraction (PAF; from published global OSA prevalence estimates) were computed. RESULTS We included four observational studies (N = 2,839,325), all with moderate/low risk of bias. OSA diagnosis was associated with twofold incidence of thyroid carcinoma (pooled HR 2.32, 95% CI 1.35-3.98, I2 = 95%), after multi-adjustment for demographics, BMI, smoking, alcohol, and comorbidities. Subgroup analysis of studies with at least 5 years of follow-up showed a stronger association of OSA with thyroid cancer incidence (pooled HR 3.27, 95% CI 2.80-3.82, I2 = 0%). Up to 14.5% (95% CI 4.29-27.6%) of incident thyroid carcinomas globally may be associated with OSA. Thyroid carcinoma mortality data was unavailable. CONCLUSIONS OSA is associated with higher thyroid carcinoma incidence, though this does not prove causation. Biological/clinical studies should investigate OSA severity in relation to thyroid carcinoma progression and mortality, stratified by tumor histology.
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Affiliation(s)
- Benjamin Kye Jyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Nicole Kye Wen Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Dominic Wei Ting Yap
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Jaivikash Raghupathy
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Esther Yanxin Gao
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Song Tar Toh
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Outram Road, Singapore, 169608, Singapore.,Surgery Academic Clinical Program, SingHealth, Singapore, Singapore
| | - Anna See
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Outram Road, Singapore, 169608, Singapore. .,Surgery Academic Clinical Program, SingHealth, Singapore, Singapore.
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16
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Gambino F, Bonsignore MR. Can CPAP protect from cancer incidence in obstructive sleep apnoea patients? No evidence yet. Eur Respir J 2022; 59:59/4/2102742. [DOI: 10.1183/13993003.02742-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 10/22/2021] [Indexed: 11/05/2022]
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17
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Cao Y, Ning P, Li Q, Wu S. Cancer and obstructive sleep apnea: An updated meta-analysis. Medicine (Baltimore) 2022; 101:e28930. [PMID: 35451384 PMCID: PMC8913079 DOI: 10.1097/md.0000000000028930] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/08/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The relationship between cancers and obstructive sleep apnea (OSA) has been discussed for decades. However, the previous meta-analysis led to opposite conclusions. To further investigate this controversial issue, we performed this systematic review and meta-analysis update. METHODS PubMed, Embase, and the Cochrane Library were systematically searched and studies on "cancer and OSA" were all included. Two reviewers independently searched articles, extracted data, and assessed the quality of included studies. Moreover, the overall incidence of cancer and OSA in corresponding populations was calculated. RESULTS Of the 1434 titles identified, 22 articles involving more than 32.1 million patients were included in this meta-analysis. An overall incidence of OSA positive individuals in cancer was 46 (95%CI, 27-67)%, and the prevalence of cancers in OSA patients reached 1.53 (95%CI, 1.01-2.31) times higher than non-OSA individuals. CONCLUSION This meta-analysis indicated that there was a high prevalence of OSA in cancer patients, and individuals with OSA were more likely to develop tumors, and the incidence was related to the severity of OSA.
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Affiliation(s)
- Yuan Cao
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Pu Ning
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Qiao Li
- Clinical Laboratory, The Affiliated Children Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Shuang Wu
- Clinical Laboratory, The Affiliated Children Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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18
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Sillah A, Watson NF, Peters U, Biggs ML, Nieto FJ, Li CI, Gozal D, Thornton T, Barrie S, Phipps AI. Sleep problems and risk of cancer incidence and mortality in an older cohort: The Cardiovascular Health Study (CHS). Cancer Epidemiol 2022; 76:102057. [PMID: 34798387 PMCID: PMC8792277 DOI: 10.1016/j.canep.2021.102057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/17/2021] [Accepted: 10/31/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sleep problems (SP) can indicate underlying sleep disorders, such as obstructive sleep apnea, which may adversely impact cancer risk and mortality. METHODS We assessed the association of baseline and longitudinal sleep apnea and insomnia symptoms with incident cancer (N = 3930) and cancer mortality (N = 4580) in the Cardiovascular Health Study. We used Cox proportional hazards regression to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) to evaluate the associations. RESULTS Overall, 885 incident cancers and 804 cancer deaths were identified over a median follow-up of 12 and 14 years, respectively. Compared to participants who reported no sleep apnea symptoms, the risk of incident cancer was inversely associated [(HR (95%CI)] with snoring [0.84 (0.71, 0.99)]. We noted an elevated prostate cancer incidence for apnea [2.34 (1.32, 4.15)] and snoring [1.69 (1.11, 2.57)]. We also noted an elevated HR for lymphatic or hematopoietic cancers [daytime sleepiness: 1.81 (1.06, 3.08)]. We found an inverse relationship for cancer mortality with respect to snoring [0.73 (0.62, 0.8)] and apnea [(0.69 (0.51, 0.94))]. We noted a significant inverse relationship between difficulty falling asleep and colorectal cancer death [0.32 (0.15, 0.69)] and snoring with lung cancer death [0.56 (0.35, 0.89)]. CONCLUSIONS The relationship between SP and cancer risk and mortality was heterogeneous. Larger prospective studies addressing more cancer sites, molecular type-specific associations, and better longitudinal SP assessments are needed for improved delineation of SP-cancer risk dyad.
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Affiliation(s)
- Arthur Sillah
- University of Washington School of Public Health, United States; Fred Hutchinson Research Cancer Research Center, United States.
| | - Nathaniel F Watson
- Department of Neurology, University of Washington School of Medicine, United States
| | - Ulrike Peters
- University of Washington School of Public Health, United States; Fred Hutchinson Research Cancer Research Center, United States
| | - Mary L Biggs
- University of Washington School of Public Health, United States
| | - F Javier Nieto
- Oregon State University College of Public Health and Human Sciences, Corvallis, OR, United States
| | - Christopher I Li
- University of Washington School of Public Health, United States; Fred Hutchinson Research Cancer Research Center, United States
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, United States
| | | | - Sonnah Barrie
- Burrell College of Osteopathic Medicine, University Park, NM, United States
| | - Amanda I Phipps
- University of Washington School of Public Health, United States; Fred Hutchinson Research Cancer Research Center, United States
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19
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Mo J, Zeng C, Li W, Song W, Xu P. Manuscript Title: A 4-miRNAs Serum Panel for Obstructive Sleep Apnea Syndrome Screening. Nat Sci Sleep 2022; 14:2055-2064. [PMID: 36394070 PMCID: PMC9656345 DOI: 10.2147/nss.s382765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is a common chronic sleep disorder. OSAS is closely related to cardiovascular disease, metabolic disorders, cancer risk, and sudden death. This association has special significance in young people. Although it is known that OSAS has a great impact on physical health, it is estimated that 70-80% of patients with moderate-to-severe OSAS remain undiagnosed. Therefore, a new method for early diagnosis of the disease, the therapeutic effect of OSAS and prevention of complications to important. METHODS A total of 110 patients with moderate-to-severe OSAS diagnosed in the Sleep Disorders Diagnosis and Treatment Center of Peking University Shenzhen Hospital were selected. After excluding other diseases, 59 patients were finally selected as the OSAS group. In addition, 60 healthy people were selected as the control group. Serum RNA was then extracted. Eight RNA samples were randomly selected from the two groups for high-throughput miRNA sequencing. The 10 miRNAs with the greatest differences were selected as preselected markers from the results. Then, qRT-PCR was performed on the remaining RNA samples of the two groups to extract and verify the 10 miRNAs, and statistical analysis was performed between groups. RESULTS A diagnostic panel was constructed by a stepwise logistic regression model combined with the expression data of miRNAs in the validation phase. A four-miRNA panel was identified to better predict OSAS, and the model was calculated using the following formula: Logit (P)= 0.77-1.65 × miR-486-5p - 4.56 × miR-148a-3p + 1.79 × miR-744-5p + 1.13 × let-7d-3p. The AUC for the four-miRNA panel was 0.955 (95% CI: 0.899 to 0.985; sensitivity = 91.38%, specificity = 91.38%). Gene Ontology (GO) annotation and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis was included in bioinformatic analysis. CONCLUSION A 4-miRNAs panel as a diagnostic biomarker for OSAS screening is feasible.
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Affiliation(s)
- Jianming Mo
- Department of Pulmonary and Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, 518034, People's Republic of China
| | - Chao Zeng
- Department of Pulmonary and Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, 518034, People's Republic of China
| | - Wei Li
- Department of Pulmonary and Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, 518034, People's Republic of China
| | - Weidong Song
- Department of Pulmonary and Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, 518034, People's Republic of China
| | - Ping Xu
- Department of Pulmonary and Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, 518034, People's Republic of China
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Obstructive Sleep Apnea and Lung Cancer: A Systematic Review and Meta-analysis of 4,885,518 Participants. Ann Am Thorac Soc 2021; 19:469-475. [PMID: 34792438 DOI: 10.1513/annalsats.202108-960oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE In 2020, lung cancer was the leading cause of cancer deaths, and was the most common cancer in men. Though obstructive sleep apnea (OSA) has been postulated to be carcinogenic, epidemiological studies are inconclusive. OBJECTIVES We conducted this systematic review and meta-analysis to investigate the associations between OSA and the incidence and mortality of lung cancer. METHODS Four electronic databases (PubMed, Embase, Cochrane Library, and Scopus) were searched from inception till 6 June 2021 for randomized controlled trials and observational studies examining the association between sleep apnea and incident lung cancer. Two reviewers selected studies, extracted data, graded the risk of bias using the Newcastle-Ottawa scale and the quality of evidence using GRADE. Random-effects models were used to meta-analyze the maximally covariate-adjusted associations. RESULTS Seven studies were included in our systematic review; among which four were suitable for meta-analysis, comprising a combined cohort of 4,885,518 patients. Risk of bias was low to moderate. OSA was associated with a higher incidence of lung cancer (HR 1.25, 95%CI 1.02 to 1.53), with substantial heterogeneity (I²=97%). Heterogeneity was eliminated, with a stable pooled effect size, when including the three studies with at least 5 years of median follow-up (HR 1.32, 95%CI 1.27 to 1.37, I²=0%). CONCLUSIONS In this meta-analysis of 4,885,518 patients from four observational studies, patients with OSA had approximately 30% higher risk of lung cancer, compared to those without OSA. We suggest more clinical studies with longer follow-up as well as biological models of lung cancer be performed to further elucidate this relationship.
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Polysomnographic Markers of Obstructive Sleep Apnea Severity and Cancer-Related Mortality: A Large Retrospective Multicenter Clinical Cohort Study. Ann Am Thorac Soc 2021; 19:807-818. [PMID: 34788198 PMCID: PMC9116343 DOI: 10.1513/annalsats.202106-738oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The evidence for an association between cancer survival and obstructive sleep apnea (OSA) remains under-explored. OBJECTIVES To evaluate an association between markers of OSA severity (respiratory disturbances, hypoxemia, and sleep fragmentation) and cancer-related mortality in individuals with previously diagnosed cancer. METHODS We conducted a multicenter retrospective 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 Canadian academic hospitals and were previously diagnosed with cancer through the Ontario Cancer Registry. Multivariable cause-specific Cox regressions were utilized to address the research objective. RESULTS We included 2,222 subjects. Over a median follow-up time of 5.6 years (IQR: 2.7-9.1), 261/2,222 (11.7%) individuals with prevalent cancer died from cancer-related causes, which accounted for 44.2% (261/590) of all-cause death. Controlling for age, sex, alcohol use disorder, prior heart failure, COPD, hypertension, diabetes, treatment for OSA, clinic site, year of the sleep study, and time since the cancer diagnosis, measures of hypoxemia and sleep fragmentation, but not apnea-hypopnea index were significantly associated with the cancer-specific mortality: % time spent with SaO2 <90% (HR per 5% increase: 1.05; 95% CI: 1.01-1.09); mean SaO2 (HR per 3% increase: 0.79; 0.68-0.92); and % of Stage 1 Sleep (HR per 16% increase: 1.27; 1.07-1.51). CONCLUSION In a large clinical cohort of adults with suspected OSA and previously diagnosed cancer, measures of nocturnal hypoxemia and sleep fragmentation as markers of OSA severity were significantly associated with cancer-related mortality, suggesting the need for more targeted risk awareness.
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Raptis DG, Vavougios GD, Siachpazidou DI, Pastaka C, Xiromerisiou G, Gourgoulianis KI, Malli F. Intergenic SNPs in Obstructive Sleep Apnea Syndrome: Revealing Metabolic, Oxidative Stress and Immune-Related Pathways. Diagnostics (Basel) 2021; 11:diagnostics11101753. [PMID: 34679450 PMCID: PMC8534397 DOI: 10.3390/diagnostics11101753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
There is strong evidence supporting the contribution of genetic factors to obstructive sleep apnea syndrome (OSAHS) susceptibility. In the current study we analyzed both in a clinical cohort and in silico, four single nucleotide polymorphisms SNPs, rs999944, rs75108997, rs35329661 and rs116133558 that have been associated with OSAHS. In 102 patients with OSAHS and 50 healthy volunteers, genetic testing of the above polymorphisms was performed. Polymorphism rs116133558 was invariant in our study population, whereas polymorphism rs35329661 was more than 95% invariant. Polymorphism rs999944 displayed significant (>5%) variance in our study population and was used in the binary logistic regression model. In silico analyses of the mechanism by which these three SNPs may affect the pathophysiology of OSAHS revealed a transcriptomic network of 274 genes. This network was involved in multiple cancer-associated gene signatures, as well as the adipogenesis pathway. This study, uncover a regulatory network in OSAHS using transcriptional targets of intergenic SNPs, and map their contributions in the pathophysiology of the syndrome on the interplay between adipocytokine signaling and cancer-related transcriptional dysregulation.
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Affiliation(s)
- Dimitrios G. Raptis
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41334 Larissa, Greece; (D.G.R.); (G.D.V.); (D.I.S.); (C.P.); (K.I.G.)
| | - George D. Vavougios
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41334 Larissa, Greece; (D.G.R.); (G.D.V.); (D.I.S.); (C.P.); (K.I.G.)
| | - Dimitra I. Siachpazidou
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41334 Larissa, Greece; (D.G.R.); (G.D.V.); (D.I.S.); (C.P.); (K.I.G.)
| | - Chaido Pastaka
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41334 Larissa, Greece; (D.G.R.); (G.D.V.); (D.I.S.); (C.P.); (K.I.G.)
| | - Georgia Xiromerisiou
- Department of Neurology, School of Medicine, University of Thessaly, 41334 Larissa, Greece;
| | - Konstantinos I. Gourgoulianis
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41334 Larissa, Greece; (D.G.R.); (G.D.V.); (D.I.S.); (C.P.); (K.I.G.)
| | - Foteini Malli
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41334 Larissa, Greece; (D.G.R.); (G.D.V.); (D.I.S.); (C.P.); (K.I.G.)
- Respiratory Disorders Lab, Faculty of Nursing, University of Thessaly, 41334 Larissa, Greece
- Correspondence: ; Tel.: +30-241-068-4612; Fax: +30-241-350-1563
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Heterogeneity of Melanoma Cell Responses to Sleep Apnea-Derived Plasma Exosomes and to Intermittent Hypoxia. Cancers (Basel) 2021; 13:cancers13194781. [PMID: 34638272 PMCID: PMC8508428 DOI: 10.3390/cancers13194781] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is associated with increased cutaneous melanoma incidence and adverse outcomes. Exosomes are secreted by most cells, and play a role in OSA-associated tumor progression and metastasis. We aimed to study the effects of plasma exosomes from OSA patients before and after adherent treatment with continuous positive airway pressure (CPAP) on melanoma cells lines, and also to identify exosomal miRNAs from melanoma cells exposed to intermittent hypoxia (IH) or normoxia. Plasma-derived exosomes were isolated from moderate-to-severe OSA patients before (V1) and after (V2) adherent CPAP treatment for one year. Exosomes were co-incubated with three3 different melanoma cell lines (CRL 1424; CRL 1619; CRL 1675) that are characterized by genotypes involving different mutations in BRAF, STK11, CDKN2A, and PTEN genes to assess the effect of exosomes on cell proliferation and migration, as well as on pAMK activity in the presence or absence of a chemical activator. Subsequently, CRL-1424 and CRL-1675 cells were exposed to intermittent hypoxia (IH) and normoxia, and exosomal miRNAs were identified followed by GO and KEG pathways and gene networks. The exosomes from these IH-exposed melanoma cells were also administered to THP1 macrophages to examine changes in M1 and M2 polarity markers. Plasma exosomes from V1 increased CRL-1424 melanoma cell proliferation and migration compared to V2, but not the other two cell lines. Exposure to CRL-1424 exosomes reduced pAMPK/tAMPK in V1 compared to V2, and treatment with AMPK activator reversed the effects. Unique exosomal miRNAs profiles were identified for CRL-1424 and CRL-1675 in IH compared to normoxia, with six miRNAs being regulated and several KEGG pathways were identified. Two M1 markers (CXCL10 and IL6) were significantly increased in monocytes when treated with exosomes from IH-exposed CRL-1424 and CRL-1625 cells. Our findings suggest that exosomes from untreated OSA patients increase CRL-1424 melanoma malignant properties, an effect that is not observed in two other melanoma cell lines. Exosomal cargo from CRL-1424 cells showed a unique miRNA signature compared to CRL-1675 cells after IH exposures, suggesting that melanoma cells are differentially susceptible to IH, even if they retain similar effects on immune cell polarity. It is postulated that mutations in STK-11 gene encoding for the serine/threonine kinase family that acts as a tumor suppressor may underlie susceptibility to IH-induced metabolic dysfunction, as illustrated by CRL-1424 cells.
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Balachandran DD, Miller MA, Faiz SA, Yennurajalingam S, Innominato PF. Evaluation and Management of Sleep and Circadian Rhythm Disturbance in Cancer. Curr Treat Options Oncol 2021; 22:81. [PMID: 34213651 DOI: 10.1007/s11864-021-00872-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT Sleep and circadian rhythm disturbance are among the most commonly experienced symptoms in patients with cancer. These disturbances occur throughout the spectrum of cancer care from diagnosis, treatment, and long into survivorship. The pathogenesis of these symptoms and disturbances is based on common inflammatory pathways related to cancer and its' treatments. The evaluation of sleep and circadian disorders requires an understanding of how these symptoms cluster with other cancer-related symptoms and potentiate each other. A thorough evaluation of these symptoms and disorders utilizing validated diagnostic tools, directed review of clinical information, and diagnostic testing is recommended. Treatment of sleep and circadian disturbance in cancer patients should be based on the findings of a detailed evaluation, including specific treatment of primary sleep and circadian disorders, and utilize integrative and personalised management of cancer-related symptoms through multiple pharmacologic and non-pharmacologic modalities. Recognition, evaluation, and treatment of sleep and circadian rhythm disturbance in cancer may lead to improved symptom management, quality of life, and outcomes.
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Affiliation(s)
- Diwakar D Balachandran
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street. Unit 1462, Houston, TX, 77030-4009, USA.
| | - Michelle A Miller
- Division of Health Sciences (Mental Health & Wellbeing), University of Warwick, Warwick Medical School, Gibbet Hill, Coventry, UK
| | - Saadia A Faiz
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street. Unit 1462, Houston, TX, 77030-4009, USA
| | - Sriram Yennurajalingam
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pasquale F Innominato
- North Wales Cancer Treatment Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK
- Cancer Chronotherapy Team, Warwick Medical School, Coventry, UK
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25
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Choi JH, Lee JY, Lim YC, Kim JK, Do Han K, Cho JH. Association between obstructive sleep apnea and thyroid cancer incidence: a national health insurance data study. Eur Arch Otorhinolaryngol 2021; 278:4569-4574. [PMID: 34032908 DOI: 10.1007/s00405-021-06896-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Little is known about the incidence of thyroid cancer in patients with obstructive sleep apnea (OSA). This study aimed to evaluate whether OSA is associated with the incidence of thyroid cancer based on the Korea National Health Insurance Service (KNHIS) database. METHODS This study was designed as a retrospective cohort data analysis of the KNHIS dataset. A total of 198,574 patients who were over 20 years of age and had been newly diagnosed with OSA between 2007 and 2014 were enrolled. A control group of 992,870 individuals was selected based on propensity score matching by age and sex. The mean follow-up duration was 4.5 ± 2.3 years. The primary endpoint was the incidence of newly diagnosed thyroid cancer. RESULTS The hazard ratio (HR) for thyroid cancer incidence among OSA patients compared to the control was 1.72 (95% confidence interval [CI] 1.60-1.84) based on Model 1 (not adjusted by any covariate) and 1.64 (95% CI 1.53-1.76) based on Model 2 (adjusted by income level, diabetes, hypertension, and dyslipidemia). Thyroid cancer incidence was significantly higher in male patients (HR = 1.93, 95% CI 1.74-2.12) than female ones (HR = 1.39, 95% CI 1.26-1.54). When compared by age, the HR of thyroid cancer was higher in middle-aged (40 ≤ age < 65 years) patients (HR = 1.68, 95% CI 1.55-1.83) than in young (20 ≤ age < 40 years, HR = 1.53, 95% CI 1.32-1.77) or old (65 ≤ age, HR = 1.28, 95% CI 0.94-1.74) patients. CONCLUSION OSA may increase the risk of developing thyroid cancer, especially in middle-aged men.
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Affiliation(s)
- Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Jae Yong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Young Chang Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konkuk University College of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea
| | - Jin Kook Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konkuk University College of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Jae Hoon Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konkuk University College of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
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Huang T, Lin BM, Stampfer MJ, Schernhammer ES, Saxena R, Tworoger SS, Redline S. Associations of self-reported obstructive sleep apnea with total and site-specific cancer risk in older women: a prospective study. Sleep 2021; 44:5917873. [PMID: 33015707 DOI: 10.1093/sleep/zsaa198] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic intermittent hypoxia resulting from obstructive sleep apnea (OSA) may activate multiple carcinogenic pathways and lead to cancer development. METHODS We prospectively examined the association between OSA and cancer risk among 65,330 women in the Nurses' Health Study who were free of cancer in 2008 (mean age: 73.3 years). Incident cancer diagnoses were collected until 2016 and confirmed by pathology reports. Clinically diagnosed OSA was self-reported in 2008 and updated in 2012. We used time-dependent Cox regression to estimate hazard ratios (HR) for the associations of OSA with total and site-specific cancer risk. RESULTS We documented 5,257 incident cancer diagnoses during follow-up. In the age-adjusted model, OSA was associated with a 15% (95% CI: 1.03, 1.29) increase in total cancer risk. The association became nonsignificant after adjustment for multiple cancer risk factors (HR: 1.08; 95% CI: 0.96, 1.21). When examining cancer risk by site, OSA was associated with significantly increased risk for lung (fully adjusted HR: 1.52; 95% CI: 1.07, 2.17), bladder (fully adjusted HR: 1.94; 95% CI: 1.12, 3.35), and thyroid cancer (fully adjusted HR: 2.06; 95% CI: 1.01, 4.22) and possibly increased risk for kidney cancer (fully adjusted HR: 1.59; 95% CI: 0.84, 3.01). When grouping cancer sites by risk factor profiles, OSA was positively associated with smoking-related cancers (fully adjusted HR: 1.37; 95% CI: 1.11, 1.67), and this association was stronger in never smokers than ever smokers. CONCLUSION While OSA was not independently associated with overall cancer risk in older women, significant associations were observed for smoking-related cancers, especially in nonsmokers.
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Affiliation(s)
- Tianyi Huang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Brian M Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Meir J Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Eva S Schernhammer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Richa Saxena
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Shelley S Tworoger
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Min HJ, Park JS, Kim KS, Kang M, Seo JH, Yoon JH, Kim CH, Cho HJ. Serum high-mobility group box 1 protein level correlates with the lowest SaO 2 in patients with sleep apnea: a preliminary study. Braz J Otorhinolaryngol 2021; 88:875-881. [PMID: 33461910 PMCID: PMC9615530 DOI: 10.1016/j.bjorl.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/26/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Serum level of high-mobility group box 1 protein is reportedly correlated with the severity of obstructive sleep apnea. Objective We tried to evaluate the possibility of using the serum high-mobility group box 1 protein level as a biologic marker in obstructive sleep apnea patients. Methods We generated a chronic intermittent hypoxia murine model that reflected human obstructive sleep apnea. Obstructive sleep apnea patients who underwent polysomnography were prospectively enrolled. Serum samples were obtained from mice and obstructive sleep apnea patients, and the serum high-mobility group box1 protein level was measured by enzyme-linked immunosorbent assay. Results Serum high-mobility group box 1 protein level was 56.16 ± 30.33 ng/mL in chronic intermittent hypoxia and 18.63 ± 6.20 ng/mL in control mice (p < 0.05). The mean apnea-hypopnea index and respiratory disturbance index values of enrolled obstructive sleep apnea patients were 50.35 ± 27.96 and 51.56 ± 28.53, respectively, and the mean serum high-mobility group box 1 protein level was 30.13 ± 19.97 ng/mL. The apnea–hypopnea index and respiratory disturbance index were not significantly correlated with the serum high-mobility group box 1 protein level (p > 0.05). Instead, this protein level was significantly correlated with lowest arterial oxygen concentration (SaO2) (p < 0.05). Conclusion High-mobility group box 1 protein may be involved in the pathogenesis of obstructive sleep apnea, and the possibility of this protein being a useful biologic marker in obstructive sleep apnea should be further evaluated.
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Affiliation(s)
- Hyun Jin Min
- Chung-Ang University College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea; Chung-Ang University Hospital, Biomedical Research Institute, Seoul, Republic of Korea
| | - Joon Soon Park
- Chung-Ang University College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Kyung Soo Kim
- Chung-Ang University College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Miran Kang
- Yonsei University College of Medicine, Department of Otorhinolaryngology, Seoul, Republic of Korea
| | - Ju Hee Seo
- Yonsei University College of Medicine, Department of Otorhinolaryngology, Seoul, Republic of Korea
| | - Joo-Heon Yoon
- Yonsei University College of Medicine, Department of Otorhinolaryngology, Seoul, Republic of Korea; Yonsei University College of Medicine, The Airway Mucus Institute, Seoul, Republic of Korea
| | - Chang-Hoon Kim
- Yonsei University College of Medicine, Department of Otorhinolaryngology, Seoul, Republic of Korea; Yonsei University College of Medicine, The Airway Mucus Institute, Seoul, Republic of Korea
| | - Hyung-Ju Cho
- Yonsei University College of Medicine, Department of Otorhinolaryngology, Seoul, Republic of Korea; Yonsei University College of Medicine, The Airway Mucus Institute, Seoul, Republic of Korea.
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Kendzerska T, Povitz M, Leung RS, Boulos MI, McIsaac DI, Murray BJ, Bryson GL, Talarico R, Hilton JF, Malhotra A, Gershon AS. Obstructive Sleep Apnea and Incident Cancer: A Large Retrospective Multicenter Clinical Cohort Study. Cancer Epidemiol Biomarkers Prev 2020; 30:295-304. [PMID: 33268490 DOI: 10.1158/1055-9965.epi-20-0975] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/01/2020] [Accepted: 11/20/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To examine the association between the severity of obstructive sleep apnea (OSA) and nocturnal hypoxemia with incident cancer. METHODS This was 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; and 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 of 33,711 (7%) individuals developed cancer, with an incidence rate of 10.3 (10.0-10.8) per 1,000 person-years. Controlling for confounders, severe OSA was associated with a 15% increased hazard of developing cancer compared with no OSA (HR = 1.15, 1.02-1.30; ARD = 1.28%, 0.20-2.37; and 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; and NNH = 42). CONCLUSIONS In a large cohort of individuals with suspected OSA free of cancer at baseline, the severity of OSA and nocturnal hypoxemia was independently associated with incident cancer. IMPACT These findings suggest the need for more targeted cancer risk awareness in individuals with OSA.
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Affiliation(s)
- Tetyana Kendzerska
- Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada.
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Richard S Leung
- Department of Medicine, the University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mark I Boulos
- Department of Medicine, the University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Daniel I McIsaac
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Departments of Anesthesiology and Pain Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | - Brian J Murray
- Department of Medicine, the University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gregory L Bryson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Departments of Anesthesiology and Pain Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Talarico
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada
| | - John F Hilton
- Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | - Atul Malhotra
- Department of Medicine, the University of California, San Diego, California
| | - Andrea S Gershon
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada
- Department of Medicine, the University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Cubillos-Zapata C, Martínez-García MÁ, Díaz-García E, Toledano V, Campos-Rodríguez F, Sánchez-de-la-Torre M, Nagore E, Martorell-Calatayud A, Hernández Blasco L, Pastor E, Abad-Capa J, Montserrat JM, Cabriada-Nuño V, Cano-Pumarega I, Corral-Peñafiel J, Arias E, Mediano O, Somoza-González M, Dalmau-Arias J, Almendros I, Farré R, López-Collazo E, Gozal D, García-Río F. Proangiogenic factor midkine is increased in melanoma patients with sleep apnea and induces tumor cell proliferation. FASEB J 2020; 34:16179-16190. [PMID: 33058223 DOI: 10.1096/fj.202001247rr] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022]
Abstract
Midkine (MDK) might mediate the proangiogenic effect of intermittent hypoxia (IH) in patients with obstructive sleep apnea (OSA) and cutaneous melanoma (CM). We compare circulating MDK in CM patients with and without OSA, and their relationship with tumor aggressiveness, while exploring in vitro effects of soluble MDK on human lymphatic endothelial (HLEC) and melanoma cell proliferation. In 360 CM patients, sleep studies and MDK serum level measurements were performed. The effect of MDK on cell proliferation was assessed using HLEC and melanoma cell lines with patient sera under both normoxia and IH. MDK levels were higher in severe OSA compared to mild OSA or non-OSA patients, whereas no differences in VEGF levels emerged. In OSA patients, MDK levels correlated with nocturnal hypoxemia and CM mitotic rate. In vitro, MDK promotes HLEC proliferation under IH conditions. Moreover, cultures of the human melanoma cell line C81-61 with sera from patients with the highest MDK levels promoted tumor cell proliferation, which was attenuated after the addition of MDK antibody. These responses were enhanced by IH exposures. In conclusion, in CM patients, OSA severity is associated with higher MDK levels, which, appear to enhance both the lymphangiogenesis as the intrinsic aggressiveness of CM tumor cells.
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Affiliation(s)
- Carolina Cubillos-Zapata
- Grupo de Enfermedades Respiratorias, Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | - Elena Díaz-García
- Grupo de Enfermedades Respiratorias, Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Victor Toledano
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- TumorImmunology Laboratory IdiPAZ, Madrid, Spain
- Innate Immune Response Group, IdiPAZ, Madrid, Spain
| | - Francisco Campos-Rodríguez
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital Universitario de Valme, IBIS, Seville, Spain
| | - Manuel Sánchez-de-la-Torre
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Group of Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Eduardo Nagore
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Luis Hernández Blasco
- Respiratory Department, ISABIAL, Hospital General Universitario de Alicante, Alicante, Spain
- Departamento Medicina Clinica, Universidad Miguel Hernandez, Elche, Spain
| | - Esther Pastor
- Respiratory Department, Hospital san Juan de Alicante, Alicante, Spain
| | - Jorge Abad-Capa
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Centro de investigacion Biomedica, Hospital Germans Trias i Pujol, Madrid, Spain
| | - Josep María Montserrat
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital Clinic- IDIBAPS, Barcelona, Spain
| | | | | | - Jaime Corral-Peñafiel
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital Universitario S. Pedro Alcántara, Cáceres, Spain
| | - Eva Arias
- Respiratory Department, Hospital 12 de Octubre, Madrid, Spain
| | - Olga Mediano
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | - Joan Dalmau-Arias
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Isaac Almendros
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ramón Farré
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduardo López-Collazo
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- TumorImmunology Laboratory IdiPAZ, Madrid, Spain
- Innate Immune Response Group, IdiPAZ, Madrid, Spain
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MI, United States
| | - Francisco García-Río
- Grupo de Enfermedades Respiratorias, Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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Gozal D, Almendros I, Phipps AI, Campos-Rodriguez F, Martínez-García MA, Farré R. Sleep Apnoea Adverse Effects on Cancer: True, False, or Too Many Confounders? Int J Mol Sci 2020; 21:ijms21228779. [PMID: 33233617 PMCID: PMC7699730 DOI: 10.3390/ijms21228779] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is a prevalent disorder associated with increased cardiovascular, metabolic and neurocognitive morbidity. Recently, an increasing number of basic, clinical and epidemiological reports have suggested that OSA may also increase the risk of cancer, and adversely impact cancer progression and outcomes. This hypothesis is convincingly supported by biological evidence linking certain solid tumours and hypoxia, as well as by experimental studies involving cell and animal models testing the effects of intermittent hypoxia and sleep fragmentation that characterize OSA. However, the clinical and epidemiological studies do not conclusively confirm that OSA adversely affects cancer, even if they hold true for specific cancers such as melanoma. It is likely that the inconclusive studies reflect that they were not specifically designed to test the hypothesis or because of the heterogeneity of the relationship of OSA with different cancer types or even sub-types. This review critically focusses on the extant basic, clinical, and epidemiological evidence while formulating proposed directions on how the field may move forward.
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Affiliation(s)
- David Gozal
- Department of Child Health, The University of Missouri School of Medicine, Columbia, MO 65201, USA
- Correspondence: (D.G.); (R.F.)
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain;
- CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain;
- Institut d’Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain
| | - Amanda I. Phipps
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA 98195, USA;
- Epidemiology Program, Fred Hutchinson Research Cancer Research Center, Seattle, WA 98109, USA
| | - Francisco Campos-Rodriguez
- CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain;
- Respiratory Department, Hospital Valme (Seville, Spain), Institute of Biomedicine of Seville (IBiS), 41014 Seville, Spain
| | - Miguel A. Martínez-García
- Pneumology Department, Sleep-Disordered Breathing and Research Unit, Polytechnic and University La Fe Hospital, 46026 Valencia, Spain;
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain;
- CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain;
- Institut d’Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain
- Correspondence: (D.G.); (R.F.)
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31
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Picado C, Roca-Ferrer J. Role of the Cyclooxygenase Pathway in the Association of Obstructive Sleep Apnea and Cancer. J Clin Med 2020; 9:jcm9103237. [PMID: 33050416 PMCID: PMC7601393 DOI: 10.3390/jcm9103237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/16/2022] Open
Abstract
The objective of this review is to examine the findings that link obstructive sleep apnea (OSA) with cancer and the role played by the cyclooxygenase (COX) pathway in this association. Epidemiological studies in humans suggest a link between OSA and increased cancer incidence and mortality. Studies carried out in animal models have shown that intermittent hypoxia (IH) induces changes in several signaling pathways involved in the regulation of host immunological surveillance that results in tumor establishment and invasion. IH induces the expression of cyclooxygenase 2 (COX-2) that results in an increased synthesis of prostaglandin E2 (PGE2). PGE2 modulates the function of multiple cells involved in immune responses including T lymphocytes, NK cells, dendritic cells, macrophages, and myeloid-derived suppressor cells. In a mouse model blockage of COX-2/PGE2 abrogated the pro-oncogenic effects of IH. Despite the fact that aspirin inhibits PGE2 production and prevents the development of cancer, none of the epidemiological studies that investigated the association of OSA and cancer included aspirin use in the analysis. Studies are needed to investigate the regulation of the COX-2/PGE2 pathway and PGE2 production in patients with OSA, to better define the role of this axis in the physiopathology of OSA and the potential role of aspirin in preventing the development of cancer.
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Affiliation(s)
- César Picado
- Hospital Clinic, Department of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-67-947-3675; Fax: +34-93-227-2634
| | - Jordi Roca-Ferrer
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto Carlos III, 28029 Madrid, Spain
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Dodds S, Williams LJ, Roguski A, Vennelle M, Douglas NJ, Kotoulas SC, Riha RL. Mortality and morbidity in obstructive sleep apnoea-hypopnoea syndrome: results from a 30-year prospective cohort study. ERJ Open Res 2020; 6:00057-2020. [PMID: 32963994 PMCID: PMC7487348 DOI: 10.1183/23120541.00057-2020] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Obstructive sleep apnoea–hypopnoea syndrome (OSAHS) carries substantial negative health consequences. This study examines factors affecting mortality and morbidity according to continuous positive airway pressure (CPAP) use and predictors affecting CPAP adherence in a longitudinal cohort of OSAHS patients. Materials and methods This prospective, cohort study comprised 4502 patients who were diagnosed with OSAHS at a tertiary sleep disorders centre between 1982 and 2003. Of these, 1174 patients completed follow-up in 2012. Data collected included anthropometric, sleep and demographic characteristics, including comorbidities, ongoing medications and CPAP adherence. Patients were followed up for an average of 14.8±3.7 years. Results Imputation analysis showed that long-term CPAP users (>5 years) were 5.63 times more likely to be alive at study end than non-CPAP users (95% CI: 4.83–6.58, p<0.001) and 1.74-times more likely than short-term CPAP users (≤5 years) (95% CI: 1.49–2.02, p<0.001). Females had a significantly higher mortality rate during the follow-up period (26.8% versus 19.6%, p<0.001). Respiratory mortality was more common in patients with OSAHS, in particular those who did not use CPAP, compared to the general population (17.2% versus 12.2%, p=0.002 respectively), whereas deaths from cancer were less common compared to the general population (16.2% versus 25.6%, p<0.001). Compared to CPAP users, non-CPAP-users had a significantly increased incidence of type II diabetes mellitus (DMII) (27.9% versus 18.7%, p=0.003), ischaemic heart disease (IHD) (25.5% versus 12.7%, p<0.001) and myocardial infarction (MI) (14.7% versus 4.2%, p<0.001) at long-term follow-up. Conclusions Long-term CPAP use in men and women with OSAHS reduces mortality and decreases the incidence of DMII and cardiovascular disease. In this first long-term prospective cohort study to use imputation analysis in OSAHS patients, all-cause morbidity and mortality were significantly reduced in long-term CPAP users (>5 years), and equivalent for both males and femaleshttps://bit.ly/3cKL2HK
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Affiliation(s)
- Sophie Dodds
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Linda J Williams
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Amber Roguski
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Neil J Douglas
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Renata L Riha
- Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
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33
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Brzecka A, Sarul K, Dyła T, Avila-Rodriguez M, Cabezas-Perez R, Chubarev VN, Minyaeva NN, Klochkov SG, Neganova ME, Mikhaleva LM, Somasundaram SG, Kirkland CE, Tarasov VV, Aliev G. The Association of Sleep Disorders, Obesity and Sleep-Related Hypoxia with Cancer. Curr Genomics 2020; 21:444-453. [PMID: 33093806 PMCID: PMC7536792 DOI: 10.2174/1389202921999200403151720] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/31/2019] [Accepted: 03/16/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sleep disorders have emerged as potential cancer risk factors. OBJECTIVE This review discusses the relationships between sleep, obesity, and breathing disorders with concomitant risks of developing cancer. RESULTS Sleep disorders result in abnormal expression of clock genes, decreased immunity, and melatonin release disruption. Therefore, these disorders may contribute to cancer development. Moreover, in sleep breathing disorder, which is frequently experienced by obese persons, the sufferer experiences intermittent hypoxia that may stimulate cancer cell proliferation. DISCUSSION During short- or long- duration sleep, sleep-wake rhythm disruption may occur. Insomnia and obstructive sleep apnea increase cancer risks. In short sleepers, an increased risk of stomach cancer, esophageal squamous cell cancer, and breast cancer was observed. Among long sleepers (>9 hours), the risk of some hematologic malignancies is elevated. CONCLUSION Several factors including insomnia, circadian disruption, obesity, and intermittent hypoxia in obstructive sleep apnea are contributing risk factors for increased risk of several types of cancers. However, further studies are needed to determine the more significant of these risk factors and their interactions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Gjumrakch Aliev
- Address correspondence to this author at the GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX, 78229, USA; Tel: +1(440) 263-7461; +7-964-493-1515; E-mails: and
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Obstructive sleep apnea syndrome and causal relationship with female breast cancer: a mendelian randomization study. Aging (Albany NY) 2020; 12:4082-4092. [PMID: 32112550 PMCID: PMC7093176 DOI: 10.18632/aging.102725] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
Abstract
Although observational studies have reported a positive association between obstructive sleep apnea syndrome (OSAS) and breast cancer (BC) risk, causality remains inconclusive. We aim to explore whether OSAS is associated with etiology of BC by conducting a two-sample Mendelian randomization (MR) study in a Chinese population and Asian population from the Breast Cancer Association Consortium (BCAC). We found a detrimental causal effect of OSAS on BC risk in the primary analysis of our samples (IVW OR, 2.47 for BC risk per log-odds increment in OSAS risk, 95% CI = 1.86-3.27; P = 3.6×10-10). This was very similar to results of the direct observational case-control study between OSAS and BC risk (OR = 2.80; 95% CI = 2.24-3.50; P =1.4×10-19). Replication in the Asian population of the BCAC study also supported our results (IVW OR, 1.33 for BC risk per log-odds increment in OSAS risk, 95% CI = 1.13-1.56; P = 0.0006). Sensitivity analyses confirmed the robustness of our findings. We provide novel evidence that genetically determined higher risk of OSAS has a causal effect on higher risk of BC. Further studies focused on the mechanisms of the relationship between OSAS and breast carcinogenesis are needed.
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Freitas LS, Silveira AC, Martins FC, Costa-Hong V, Lebkuchen A, Cardozo KHM, Bernardes FM, Bortolotto LA, Lorenzi-Filho G, Oliveira EM, Drager LF. Severe obstructive sleep apnea is associated with circulating microRNAs related to heart failure, myocardial ischemia, and cancer proliferation. Sleep Breath 2020; 24:1463-1472. [PMID: 31898194 DOI: 10.1007/s11325-019-02003-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is associated with multiple comorbid conditions including cardiovascular diseases and cancer. There is a growing interest in exploring biomarkers to understand the related mechanisms and improve the risk stratification of OSA. Circulating microRNAs (miRNAs) are single noncoding strands of nearly 22 nucleotides that posttranscriptionally regulate target gene expression. Our aim was to identify miRNA profiles associated with OSA. METHODS We studied 48 male subjects, mostly Caucasian (63%) and overweight, divided by polysomnography into the no OSA control group (n = 6), mild OSA group (n = 12), moderate OSA group (n = 15), and severe OSA group (n = 15). The study groups were matched for age, body mass index (BMI), and body fat composition. miRNA profiles were measured from peripheral whole blood using two steps: (1) microarray analysis comprising more than 2500 miRNAs in a subsample of 12 subjects (three from each group); and (2) validation phase using real-time quantitative polymerase chain reaction (RTqPCR). RESULTS The microarray assessment identified 21 differentially expressed miRNAs among the groups. The RT-qPCR assessment showed that miR-1254 and miR-320e presented a gradual increase in expression parallel to OSA severity. Linear regression analysis showed that severe OSA was independently associated with miR-1254 (ß = 68.4; EP = 29.8; p = 0.02) and miR-320e (ß = 76.1; EP = 31.3; p = 0.02). CONCLUSION Severe OSA is independently associated with miRNAs that are involved in heart failure (miR-1254), myocardial ischemia/reperfusion (miR-320e), and cell proliferation in some cancer types (miR-1254 and miR-320e). Future investigations addressing whether these miRs may provide prognostic information in OSA are needed.
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Affiliation(s)
- Lunara S Freitas
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Hypertension Unit, Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - André C Silveira
- Laboratory of Biochemistry and Molecular Biology of the Exercise, School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
| | - Franco C Martins
- Sleep Laboratory, Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Valéria Costa-Hong
- Hypertension Unit, Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Fernanda M Bernardes
- Hypertension Unit, Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luiz A Bortolotto
- Hypertension Unit, Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Edilamar M Oliveira
- Laboratory of Biochemistry and Molecular Biology of the Exercise, School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
| | - Luciano F Drager
- Hypertension Unit, Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil. .,Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo, Brazil.
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36
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Martinez-Garcia MA, Campos-Rodriguez F, Almendros I, Garcia-Rio F, Sanchez-de-la-Torre M, Farre R, Gozal D. Cancer and Sleep Apnea: Cutaneous Melanoma as a Case Study. Am J Respir Crit Care Med 2019; 200:1345-1353. [PMID: 31339332 PMCID: PMC6884053 DOI: 10.1164/rccm.201903-0577pp] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/19/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Francisco Campos-Rodriguez
- Respiratory Department, Hospital Valme, Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias, Madrid, Spain
| | - Isaac Almendros
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias, Madrid, Spain
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Francisco Garcia-Rio
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias, Madrid, Spain
- Grupo de Enfermedades Respiratorias, Servicio de Neumología, Hospital Universitario La Paz, Madrid, Spain
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Manuel Sanchez-de-la-Torre
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias, Madrid, Spain
- Respiratory Department, Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, Institut de Recerca Biomèdica de Lleida, Lleida, Spain; and
| | - Ramon Farre
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias, Madrid, Spain
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri
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Schlafapnoe – ein Risikofaktor für Malignome? SOMNOLOGIE 2019. [DOI: 10.1007/s11818-019-00224-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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38
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Liu W, Luo M, Fang YY, Wei S, Zhou L, Liu K. Relationship between Occurrence and Progression of Lung Cancer and Nocturnal Intermittent Hypoxia, Apnea and Daytime Sleepiness. Curr Med Sci 2019; 39:568-575. [DOI: 10.1007/s11596-019-2075-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 07/04/2019] [Indexed: 01/04/2023]
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Pataka A, Bonsignore MR, Ryan S, Riha RL, Pepin JL, Schiza S, Basoglu OK, Sliwinski P, Ludka O, Steiropoulos P, Anttalainen U, McNicholas WT, Hedner J, Grote L. Cancer prevalence is increased in females with sleep apnoea: data from the ESADA study. Eur Respir J 2019; 53:13993003.00091-2019. [PMID: 31109987 DOI: 10.1183/13993003.00091-2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/05/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria R Bonsignore
- Biomedical Dept of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo and CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Silke Ryan
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital and School of Medicine, University College Dublin, Dublin, Ireland
| | - Renata L Riha
- Dept of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Jean-Louis Pepin
- University Grenoble Alpes, INSERM HP2 (U1042) and Grenoble University Hospital, Grenoble, France
| | - Sofia Schiza
- Sleep Disorders Unit, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Ozen K Basoglu
- Dept of Chest Diseases, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Pawel Sliwinski
- 2nd Dept of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Ondrej Ludka
- Dept of Cardiology, University Hospital Brno and International Clinical Research Center, St. Ann's University Hospital, Brno, Czech Republic
| | - Paschalis Steiropoulos
- Sleep Unit, Dept of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ulla Anttalainen
- Division of Medicine, Dept of Pulmonary Diseases, Turku University Hospital and Sleep Research Centre, Dept of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Walter T McNicholas
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital and School of Medicine, University College Dublin, Dublin, Ireland
| | - Jan Hedner
- Pulmonary Dept, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ludger Grote
- Pulmonary Dept, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Sillah A, Watson NF, Gozal D, Phipps AI. Obstructive sleep apnea severity and subsequent risk for cancer incidence. Prev Med Rep 2019; 15:100886. [PMID: 31193286 PMCID: PMC6525275 DOI: 10.1016/j.pmedr.2019.100886] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/22/2019] [Accepted: 04/29/2019] [Indexed: 12/26/2022] Open
Abstract
In vitro and animal models suggest that obstructive sleep apnea (OSA) increases cancer risk. However, the impact of OSA severity on cancer risk is poorly understood. We conducted a case-cohort study (a variant of the case-control study design), nested in a cohort of patients with a clinical diagnosis of OSA. OSA patients diagnosed between 2005 and 2013 were linked to a population-based cancer registry to identify cancers diagnosed subsequent to OSA between 2005 and 2015. Medical records were reviewed for a representative sample of 1162 OSA patients from this cohort (including 24 with subsequent cancer), and for an additional 304 OSA patients diagnosed with cancer; information regarding OSA severity indicators, including apnea-hypopnea index (AHI) was abstracted from these records. Adjusted Cox proportional hazards regression were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for associations of OSA severity indicators on cancer incidence. Compared with individuals in the lowest AHI category (5–14.9), indicating mild OSA, the adjusted HR (95% CI) for cancer incidence associated with having moderate (15–29.9) or severe (30+) OSA were 0.72 (0.40–1.29) and 0.87 (0.52–1.45) respectively. Associations with other severity indicators were not significantly associated with cancer. However, the proportion of patients with severe OSA (AHI ≥30) was consistently higher across numerous cancer sites relative to the subcohort, suggesting increased cancer risk relative to patients with less severe OSA. The absence of significant associations with OSA severity measures suggest that the underlying mechanisms deserve further investigation.
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Affiliation(s)
- Arthur Sillah
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.,Epidemiology Program, Fred Hutchinson Research Cancer Research Center, Seattle, WA, USA
| | - Nathaniel F Watson
- University of Washington School of Medicine, Department of Neurology and University of Washington Medicine Sleep Center, Seattle, WA, USA
| | - David Gozal
- University of Missouri School of Medicine, Department of Child Health, Columbia, MO, USA
| | - Amanda I Phipps
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.,Epidemiology Program, Fred Hutchinson Research Cancer Research Center, Seattle, WA, USA
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McNicholas WT. Obstructive sleep apnoea and comorbidity - an overview of the association and impact of continuous positive airway pressure therapy. Expert Rev Respir Med 2019; 13:251-261. [PMID: 30691323 DOI: 10.1080/17476348.2019.1575204] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is highly prevalent and there is considerable evidence supporting an independent association with a wide range of co-morbidities including cardiovascular, endocrine and metabolic, neuropsychiatric, pulmonary, and renal. Areas covered: A PubMed search of all the recent literature relating to OSA and co-morbidities was undertaken to critically evaluate the potential relationships and possible benefit of continuous positive airway pressure (CPAP) therapy. Expert commentary: The evidence supporting an independent association is stronger for some co-morbidities than others and in cardiovascular diseases is strongest for hypertension and atrial fibrillation. Potential mechanisms include intermittent hypoxia, fluctuating intrathoracic pressure, and recurring micro-arousals that trigger cell and molecular consequences including sympathetic excitation, systemic inflammation and oxidative stress, in addition to metabolic and endothelial dysfunction. Different mechanisms may predominate in individual co-morbidities. Recent long term randomised controlled trials have cast doubt on benefits to co-morbidities from CPAP therapy of OSA, especially where co-morbidities are already established. However, benefits may result in patients who are compliant with therapy and further research is required to clearly establish the role of OSA therapy in both primary and secondary prevention of co-morbidities.
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Affiliation(s)
- Walter T McNicholas
- a Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group and School of Medicine , University College Dublin , Dublin , Ireland.,b First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
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42
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Differential expression of immune markers in the patients with obstructive sleep apnea/hypopnea syndrome. Eur Arch Otorhinolaryngol 2018; 276:735-744. [DOI: 10.1007/s00405-018-5219-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 11/23/2018] [Indexed: 12/21/2022]
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43
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Clinical Evaluation for Oral Appliance Therapy. Sleep Med Clin 2018; 13:489-501. [DOI: 10.1016/j.jsmc.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sillah A, Watson NF, Schwartz SM, Gozal D, Phipps AI. Sleep apnea and subsequent cancer incidence. Cancer Causes Control 2018; 29:987-994. [PMID: 30120643 DOI: 10.1007/s10552-018-1073-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/12/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE In vitro and animal models suggest that the physiological effects of sleep apnea could contribute to cancer risk, yet epidemiologic studies have been inconsistent. METHODS We identified a cohort of adults diagnosed with sleep apnea between 2005 and 2014 using regional administrative databases. Linking this cohort to a population-based cancer registry, we identified first incident cancers diagnosed after sleep apnea diagnosis through 2015. We calculated age-sex standardized cancer incidence ratios (SIRs) to compare the observed number of cancers among those with sleep apnea with expected population estimates over a comparable period. RESULTS Among 34,402 individuals with sleep apnea, 1,575 first incident cancers were diagnosed during follow-up (mean ± SD; 5.3 ± 2.0 years). Compared to the general population, cancer incidence (SIR 1.26, 95% CI 1.20-1.32) was elevated among sleep apnea patients. We observed significantly elevated incidence for kidney (SIR 2.24, 95% CI 1.82-2.72), melanoma (SIR 1.71, 95% CI 1.42-2.03), breast (SIR 1.43, 95% CI 1.76-2.00), and corpus uteri (SIR 2.80, 95% CI 2.24-2.47) while risk for lung (SIR 0.66, 95% CI 0.54-0.79) and colorectal cancer (SIR 0.71, 95% CI 0.56-0.89) was lower. CONCLUSION These findings suggest an elevated cancer burden, particularly at certain sites, among individuals with diagnosed sleep apnea. Results should be interpreted with caution due to unmeasured confounders (e.g., BMI, diabetes).
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Affiliation(s)
- Arthur Sillah
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA. .,Epidemiology Program, Fred Hutchinson Research Cancer Research Center, Seattle, WA, USA.
| | - Nathaniel F Watson
- Department of Neurology, University of Washington Medicine Sleep Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Stephen M Schwartz
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.,Epidemiology Program, Fred Hutchinson Research Cancer Research Center, Seattle, WA, USA
| | - David Gozal
- Department of Child Health, The University of Missouri School of Medicine, Columbia, MO, USA
| | - Amanda I Phipps
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.,Epidemiology Program, Fred Hutchinson Research Cancer Research Center, Seattle, WA, USA
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Santamaria-Martos F, Benítez I, Girón C, Barbé F, Martínez-García MA, Hernández L, Montserrat JM, Nagore E, Martorell A, Campos-Rodriguez F, Corral J, Cabriada V, Abad J, Mediano O, Troncoso MF, Cano-Pumarega I, Fortuna Gutierrez AM, Diaz-Cambriles T, Somoza-Gonzalez M, Almendros I, Farre R, Gozal D, Sánchez-de-la-Torre M. Biomarkers of carcinogenesis and tumour growth in patients with cutaneous melanoma and obstructive sleep apnoea. Eur Respir J 2018. [PMID: 29519923 DOI: 10.1183/13993003.01885-2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The goal of this study was to assess the relationship between the severity of obstructive sleep apnoea (OSA) and the levels of carcinogenesis- and tumour growth-related biomarkers in patients with cutaneous melanoma.This multicentre observational study included patients who were newly diagnosed with melanoma. The patients were classified as non-OSA (apnoea-hypopnoea index (AHI) 0-5 events·h-1), mild OSA (AHI 5-15 events·h-1) and moderate-severe OSA (AHI >15 events·h-1). ELISAs were performed to analyse the serum levels of hypoxia- and tumour adhesion-related biomarkers (vascular endothelial growth factor (VEGF), interleukin (IL)-8, intracellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM)-1) and markers of tumour aggressiveness (S100 calcium-binding protein B (S100B) and melanoma inhibitory activity (MIA)). A logistic model adjusted for age, sex and body mass index was fitted to each biomarker, and the AHI served as the dependent variable.360 patients were included (52.2% male, median (interquartile range) age 55.5 (43.8-68.0) years and AHI 8.55 (2.8-19.5) events·h-1). The levels of VEGF, IL-8, ICAM-1, S100B and MIA were not related to the severity of OSA. The levels of VCAM-1 were higher in patients with OSA than those without OSA (mild OSA: odds ratio (OR) 2.07, p=0.021; moderate-severe OSA: OR 2.35, p=0.013).In patients with cutaneous melanoma, OSA was associated with elevated circulating levels of VCAM-1 that could indicate the contribution of OSA in tumorigenesis via integrin-based adhesion.
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Affiliation(s)
- Fernando Santamaria-Martos
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Ivan Benítez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Cristina Girón
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | - Luis Hernández
- Pneumology Dept, Hospital General de Alicante, Alicante, Spain
| | | | - Eduardo Nagore
- Dermatology Dept, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | | | - Jaime Corral
- Pneumology Dept, Hospital San Pedro de Alcantara, Cáceres, Spain
| | | | - Jorge Abad
- Pneumology Dept, Hospital Germans Trial i Pujol, Barcelona, Spain
| | - Olga Mediano
- Pneumology Dept, Hospital de Guadalajara, Guadalajara, Spain
| | | | | | | | - Trinidad Diaz-Cambriles
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Pneumology Dept, Hospital 12 de Octubre, Madrid, Spain
| | | | - Isaac Almendros
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Ramon Farre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - David Gozal
- Dept of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Manuel Sánchez-de-la-Torre
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova y Santa Maria, IRB Lleida, Lleida, Spain .,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Decrease of perforin positive CD3 +γδ-T cells in patients with obstructive sleep disordered breathing. Sleep Breath 2017; 22:211-221. [PMID: 29247296 PMCID: PMC5835055 DOI: 10.1007/s11325-017-1602-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 10/02/2017] [Accepted: 12/03/2017] [Indexed: 12/04/2022]
Abstract
Introduction Sleep related breathing disorders (SRBD) cause sleep fragmentation, intermittent hypoxia or a combination of both leading to homeostasis perturbations, including in the immune system. We investigated whether SRBD patients with or without intermittent hypoxia show substantial differences in perforin and granzyme-B positive peripheral blood lymphocytes. Methods A total of 87 subjects were included and distributed as follows: 24 controls (C), 19 patients with respiratory effort related arousals due to increased upper airway resistance (UAR) without hypoxic events, 24 obese patients with obstructive sleep apnea (OSA) (oOSA), and 20 without obesity (noOSA). After polysomnographic recording, we analyzed in fasting blood samples routine hematologic and biochemical parameters and the percentage of lymphocytes containing the proteins perforin and granzyme-B (GrB). Kruskal-Wallis tests and a posteriori multiple comparisons were applied for statistical analysis of results. Results Perforin-positive γδ-cells revealed significant differences between groups (p = 0.017), especially between the Control group and the oOSA (p-value = 0.04); the remaining SRBD groups also showed differences from the control (C vs UAR: p = 0.08; C vs noOSA = 0.09), but they did not raise to statistical significance. There were no differences among the SRBD groups. Granzyme-B cells were decreased in SRBD patients, but the differences were not statistically significant. No additional statistical significant result was found in the other investigated lymphocyte subsets. Conclusions Obstructive sleep-disordered breathing is associated with a decrease in perforin-positive CD3+γδ-T cells. Although this finding was detected in lean patients without intermittent hypoxia, the reduction was only statistically significant in obese patients with severe OSA. Because CD3+γδ-T cells play an important role in the control of tumor cells, our findings are directly relevant for the study of the association of OSA and cancer. Electronic supplementary material The online version of this article (10.1007/s11325-017-1602-6) contains supplementary material, which is available to authorized users.
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Almendros I, Gozal D. Intermittent hypoxia and cancer: Undesirable bed partners? Respir Physiol Neurobiol 2017; 256:79-86. [PMID: 28818483 DOI: 10.1016/j.resp.2017.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/27/2017] [Accepted: 08/10/2017] [Indexed: 12/30/2022]
Abstract
The deleterious effects of intermittent hypoxia (IH) on cancer biology have been primarily evaluated in the context of the aberrant circulation observed in solid tumors which results in recurrent intra-tumoral episodic hypoxia. From those studies, IH has been linked to an accelerated tumor progression, metastasis and resistance to therapies. More recently, the role of IH in cancer has also been studied in the context of obstructive sleep apnea (OSA), since IH is a hallmark characteristic of this condition. Such recent studies are undoubtedly adding more information regarding the role of IH on tumor malignancy. In terms of the IH patterns associated with OSA, this altered oxygenation paradigm has been recently proposed as a determinant factor in fostering cancer incidence and progression from both in vitro and in vivo experimental models. Here, we summarize all the available evidence to date linking IH effects on several types of cancer.
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Affiliation(s)
- Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 28029 Madrid, Spain.
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, United States
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Up-regulation of selenoprotein P and HIP/PAP mRNAs in hepatocytes by intermittent hypoxia via down-regulation of miR-203. Biochem Biophys Rep 2017; 11:130-137. [PMID: 28955777 PMCID: PMC5614699 DOI: 10.1016/j.bbrep.2017.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/01/2017] [Accepted: 07/10/2017] [Indexed: 12/12/2022] Open
Abstract
Sleep apnea syndrome is characterized by recurrent episodes of oxygen desaturation and reoxygenation (intermittent hypoxia [IH]) and is a risk factor for insulin resistance/type 2 diabetes. However, the mechanisms linking IH stress and insulin resistance remain elusive. We exposed human hepatocytes (JHH5, JHH7, and HepG2) to experimental IH or normoxia for 24 h, measured mRNA levels by real-time reverse transcription polymerase chain reaction (RT-PCR), and found that IH significantly increased the mRNA levels of selenoprotein P (SELENOP) — a hepatokine — and hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP) — one of REG (Regenerating gene) family. We next investigated promoter activities of both genes and discovered that they were not increased by IH. On the other hand, a target mRNA search of micro RNA (miRNA) revealed that both mRNAs have a potential target sequence for miR-203. The miR-203 level of IH-treated cells was significantly lower than that of normoxia-treated cells. Thus, we introduced miR-203 inhibitor and a non-specific control RNA (miR-203 inhibitor NC) into HepG2 cells and measured the mRNA levels of SELENOP and HIP/PAP. The IH-induced expression of SELENOP and HIP/PAP was abolished by the introduction of miR-203 inhibitor but not by miR-203 inhibitor NC. These results demonstrate that IH stress up-regulates the levels of SELENOP in human hepatocytes to accelerate insulin resistance and up-regulates the levels of HIP/PAP mRNAs to proliferate such hepatocytes, via the miR-203 mediated mechanism.
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Key Words
- AHSG, α2 HS-glycoprotein
- ANGPTL6, angiopoietin-related growth factor
- DICER, endoribonuclease Dicer
- DROSHA, ribonuclease type III
- ELISA, enzyme-linked immunosorbent assay
- FCS, fetal calf serum
- FGF21, fibroblast growth factor 21
- HIP/PAP
- HIP/PAP, hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein
- Hepatokine
- IH, intermittent hypoxia
- Intermittent hypoxia
- LECT2, leukocyte cell-derived chemotaxin 2
- MCPIP1, monocyte chemotactic protein-induced protein 1
- REG family gene
- Reg, regenerating gene
- Rig, rat insulinoma gene
- RpS15, ribosomal protein S15
- SAS, sleep apnea syndrome
- SELENOP
- SELENOP, selenoprotein P
- SHBG, sex hormone-binding globulin
- TP63, transformation-related protein 63
- WST-8, 2-(2-methoxy-4-nitrophenyl)−3-(4-nitrophenyl)−5-(2,4-disulfophenyl)−2H-tetrazolium monosodium salt
- miR-203
- miRNA, micro RNA
- siRNA, small interfering RNA
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Yaacoby-Bianu K, Hakim F. Sleep Disturbance and Cancer—Animal Models. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Balachandran DD, Bashoura L, Faiz SA. Sleep-Related Breathing Disorders and Cancer. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0182-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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