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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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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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Paz V, Dashti HS, Burgess S, Garfield V. Selection of genetic instruments in Mendelian randomisation studies of sleep traits. Sleep Med 2023; 112:342-351. [PMID: 37956646 PMCID: PMC7615498 DOI: 10.1016/j.sleep.2023.10.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
This review explores the criteria used for the selection of genetic instruments of sleep traits in the context of Mendelian randomisation studies. This work was motivated by the fact that instrument selection is the most important decision when designing a Mendelian randomisation study. As far as we are aware, no review has sought to address this to date, even though the number of these studies is growing rapidly. The review is divided into the following sections which are essential for genetic instrument selection: 1) Single-gene region vs polygenic analysis; 2) Polygenic analysis: biologically-vs statistically-driven approaches; 3) P-value; 4) Linkage disequilibrium clumping; 5) Sample overlap; 6) Type of exposure; 7) Total (R2) and average strength (F-statistic) metrics; 8) Number of single-nucleotide polymorphisms; 9) Minor allele frequency and palindromic variants; 10) Confounding. Our main aim is to discuss how instrumental choice impacts analysis and compare the strategies that Mendelian randomisation studies of sleep traits have used. We hope that our review will enable more researchers to take a more considered approach when selecting genetic instruments for sleep exposures.
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Affiliation(s)
- Valentina Paz
- Instituto de Psicología Clínica, Facultad de Psicología, Universidad de la República, Tristán Narvaja, 1674, Montevideo, 11200, Uruguay; MRC Unit for Lifelong Health & Ageing, Institute of Cardiovascular Science, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Hassan S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Boston, MA, 02114, USA; Broad Institute, 415 Main Street, Cambridge, MA, 02142, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Edwards 4-410C, Boston, MA, 02114, USA
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK; Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - Victoria Garfield
- MRC Unit for Lifelong Health & Ageing, Institute of Cardiovascular Science, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Li X, Wang T, Jin L, Li Z, Hu C, Yi H, Guan J, Xu H, Wu X. Overall Obesity Not Abdominal Obesity Has a Causal Relationship with Obstructive Sleep Apnea in Individual Level Data. Nat Sci Sleep 2023; 15:785-797. [PMID: 37840638 PMCID: PMC10573366 DOI: 10.2147/nss.s422917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Both obstructive sleep apnea (OSA) and obesity are highly prevalent worldwide, and are intrinsically linked. Previous studies showed that obesity is one of the major risk factors for OSA, but the causality of the relationship is still unclear. The study was to investigate the causal relationships of overall obesity and abdominal obesity with OSA and its quantitative traits. Methods In this case-control study, a total of 7134 participants, including 4335 moderate-to-severe OSA diagnosed by standard polysomnography and 2799 community-based controls were enrolled. Anthropometric and biochemical data were collected. Mendelian randomization (MR) analyses were performed using the genetic risk score, based on 29 body mass index (BMI)- and 11 waist-hip-ratio (WHR)-associated single nucleotide polymorphisms as instrumental variables. The causal associations of these genetic scores with OSA and its quantitative phenotypes were analyzed. Results Obesity was strongly correlated with OSA in observational analysis (β= 0.055, P = 3.7 × 10-5). In MR analysis, each increase by one standard deviation in BMI was associated with increased OSA risk [odds ratio (OR): 2.21, 95% confidence interval (CI): 1.62-3.02, P = 5.57 × 10-7] and with 2.72-, 4.68-, and 3.25-fold increases in AHI, ODI, and MAI, respectively (all P < 0.05) in men. However, no causal associations were found between WHR and OSA risk or OSA quantitative traits in men and women. Conclusion Compared to abdominal obesity, overall obesity showed a causal relationship with OSA and its quantitative traits, especially in men.
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Affiliation(s)
- Xinyi Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Sleep Disordered Breathing, Otorhinolaryngology Institute of Shanghai JiaoTong University, Shanghai, People’s Republic of China
| | - Tao Wang
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Li Jin
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Centre for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Zhiqiang Li
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Bio-X Institutes, Ministry of Education, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Cheng Hu
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Centre for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Hongliang Yi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Sleep Disordered Breathing, Otorhinolaryngology Institute of Shanghai JiaoTong University, Shanghai, People’s Republic of China
| | - Jian Guan
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Sleep Disordered Breathing, Otorhinolaryngology Institute of Shanghai JiaoTong University, Shanghai, People’s Republic of China
| | - Huajun Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Sleep Disordered Breathing, Otorhinolaryngology Institute of Shanghai JiaoTong University, Shanghai, People’s Republic of China
| | - Xiaolin Wu
- Central Laboratory of Shanghai Eighth People’s Hospital, Xuhui Branch of Shanghai Sixth People’s Hospital, Shanghai, People’s Republic of China
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Li W, Li C, Liu T, Wang Y, Ma X, Xiao X, Zhang Q, Qu J. Self-reported sleep disorders and the risk of all cancer types: evidence from the Kailuan Cohort study. Public Health 2023; 223:209-216. [PMID: 37677850 DOI: 10.1016/j.puhe.2023.08.007] [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: 03/13/2023] [Revised: 06/18/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Previous studies that focussed on sleep disturbance have primarily examined specific aspects of sleep disorders rather than considering overall sleep quality. We aimed to investigate different sleep disorders and their combination as risk factors for different types of cancer. STUDY DESIGN Prospective cohort study. METHODS In this prospective cohort study, we included 78,232 participants. A self-reported questionnaire was used to address insomnia, daytime sleepiness, snoring, and sleep duration. Overall sleep quality was evaluated by summarising these four sleep parameters. Cox proportional hazards analysis was used to estimate the hazard ratios and their 95% confidence intervals for determining the effect of the overall sleep-quality score and its components on the risk of incident cancer. RESULTS During a median follow-up of 5.67 years, 1266 participants were diagnosed with incident cancer. Compared to participants in the best sleep-quality score group, participants in the worst sleep-quality score group had a higher subsequent risk of overall cancer, and colorectal, breast, uterine or uterine cervical, prostatic, kidney, and bladder cancer. Participants with insomnia and snoring status had an elevated risk of head and neck, breast, uterine or uterine cervical, prostatic, kidney, bladder cancer, and lymphoma. CONCLUSIONS Poor overall sleep-quality scores as well as poor scores for the scale's components, including insomnia and snoring status, elevated the risk of overall and several specific-site cancers. TRIAL REGISTRATION Kailuan Study, ChiCTR2000029767. Registered 12 February, 2020-Retrospectively registered, https://www.chictr.org.cn/showprojEN.html?proj=48316.
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Affiliation(s)
- W Li
- Department of General Surgery, Aerospace Centre Hospital, Beijing, 100038, China
| | - C Li
- Department of Oncology, Dazu Hospital of Chongqing Medical University, Chongqing, 402360, China
| | - T Liu
- Department of Gastrointestinal Surgery/Clinical Nutrition, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China
| | - Y Wang
- Department of Hepatological Surgery, Kailuan General Hospital, Tangshan, 063000, China
| | - X Ma
- Department of Hepatological Surgery, Kailuan General Hospital, Tangshan, 063000, China
| | - X Xiao
- Department of Gynecology, Aerospace Center Hospital, 100038, China.
| | - Q Zhang
- Department of General Surgery, Kailuan General Hospital, Tangshan, 063000, China.
| | - J Qu
- Department of General Surgery, Aerospace Centre Hospital, Beijing, 100038, China.
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Shahu A, Chung J, Tarraf W, Ramos AR, González HM, Redline S, Cai J, Sofer T. Method comparison and estimation of causal effects of insomnia on health outcomes in a survey sampled population. Sci Rep 2023; 13:9831. [PMID: 37330559 PMCID: PMC10276808 DOI: 10.1038/s41598-023-36927-2] [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: 11/17/2022] [Accepted: 06/12/2023] [Indexed: 06/19/2023] Open
Abstract
Applying causal inference methods, such as weighting and matching methods, to a survey sampled population requires properly incorporating the survey weights and design to obtain effect estimates that are representative of the target population and correct standard errors (SEs). With a simulation study, we compared various approaches for incorporating the survey weights and design into weighting and matching-based causal inference methods. When the models were correctly specified, most approaches performed well. However, when a variable was treated as an unmeasured confounder and the survey weights were constructed to depend on this variable, only the matching methods that used the survey weights in causal estimation and as a covariate in matching continued to perform well. If unmeasured confounders are potentially associated with the survey sample design, we recommend that investigators include the survey weights as a covariate in matching, in addition to incorporating them in causal effect estimation. Finally, we applied the various approaches to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and found that insomnia has a causal association with both mild cognitive impairment (MCI) and incident hypertension 6-7 years later in the US Hispanic/Latino population.
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Affiliation(s)
- Anja Shahu
- Department of Biostatistics, Harvard T.H. Chan of Public Health, Boston, MA, USA
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Joon Chung
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Alberto R Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hector M González
- Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Center, University of California, San Diego, La Jolla, CA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tamar Sofer
- Department of Biostatistics, Harvard T.H. Chan of Public Health, Boston, MA, USA.
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
- CardioVascular Institute (CVI), Beth Israel Deaconness Medical Center, Boston, MA, USA.
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7
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Sleep and breast and prostate cancer risk in the MCC-Spain study. Sci Rep 2022; 12:21807. [PMID: 36526666 PMCID: PMC9758125 DOI: 10.1038/s41598-022-25789-9] [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: 04/09/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Breast and prostate cancers have been associated with circadian disruption. Some previous studies examined associations of sleep duration and breast or prostate cancer risk though findings remain inconsistent. This study examines associations of a range of detailed sleep characteristics and breast and prostate cancer risk in a large-scale population-based case-control study, MCC-Spain. A total of 1738 incident breast cancer cases, 1112 prostate cancer cases and frequency matched controls (n = 1910, and 1493 respectively) were recruited. Detailed data on habitual sleep duration, quality, timing, and daytime napping ("siesta") were collected at recruitment. Additional data on sleep habits during both the previous year and at age 40 years were also subsequently captured. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) were estimated. There were no associations of habitual sleep duration (h), timing of sleep, or any or specific sleep problems, and either breast and prostate cancer risk. There was a significant positive association of ever taking habitual siestas at recruitment and breast cancer risk (OR = 1.22, 95% CI 1.06-1.42), which strengthened with increased frequency or duration. There were also significant positive associations observed for both breast and prostate cancer, among those reporting recent sleep problems, but not sleep problems at age 40 years, in a subsequent circadian questionnaire. Adverse associations with siesta and disturbed sleep during the previous year likely reflect symptoms of developing/diagnosed cancer and comorbidities. Overall, there was no clear association between various sleep characteristics and breast or prostate cancer risk observed.
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Sonti S, Grant SFA. Leveraging genetic discoveries for sleep to determine causal relationships with common complex traits. Sleep 2022; 45:6652497. [PMID: 35908176 PMCID: PMC9548675 DOI: 10.1093/sleep/zsac180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/16/2022] [Indexed: 01/04/2023] Open
Abstract
Abstract
Sleep occurs universally and is a biological necessity for human functioning. The consequences of diminished sleep quality impact physical and physiological systems such as neurological, cardiovascular, and metabolic processes. In fact, people impacted by common complex diseases experience a wide range of sleep disturbances. It is challenging to uncover the underlying molecular mechanisms responsible for decreased sleep quality in many disease systems owing to the lack of suitable sleep biomarkers. However, the discovery of a genetic component to sleep patterns has opened a new opportunity to examine and understand the involvement of sleep in many disease states. It is now possible to use major genomic resources and technologies to uncover genetic contributions to many common diseases. Large scale prospective studies such as the genome wide association studies (GWAS) have successfully revealed many robust genetic signals associated with sleep-related traits. With the discovery of these genetic variants, a major objective of the community has been to investigate whether sleep-related traits are associated with disease pathogenesis and other health complications. Mendelian Randomization (MR) represents an analytical method that leverages genetic loci as proxy indicators to establish causal effect between sleep traits and disease outcomes. Given such variants are randomly inherited at birth, confounding bias is eliminated with MR analysis, thus demonstrating evidence of causal relationships that can be used for drug development and to prioritize clinical trials. In this review, we outline the results of MR analyses performed to date on sleep traits in relation to a multitude of common complex diseases.
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Affiliation(s)
- Shilpa Sonti
- Center for Spatial and Functional Genomics, Children’s Hospital of Philadelphia , Philadelphia, PA , USA
| | - Struan F A Grant
- Center for Spatial and Functional Genomics, Children’s Hospital of Philadelphia , Philadelphia, PA , USA
- Department of Genetics, University of Pennsylvania , Philadelphia, PA , USA
- Institute for Diabetes, Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine , Philadelphia, PA , USA
- Division of Human Genetics and Endocrinology, Children’s Hospital of Philadelphia , Philadelphia, PA , USA
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Hao S, Li F, Jiang P, Gao J. Effect of chronic intermittent hypoxia-induced HIF-1α/ATAD2 expression on lung cancer stemness. Cell Mol Biol Lett 2022; 27:44. [PMID: 35672694 PMCID: PMC9172155 DOI: 10.1186/s11658-022-00345-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/24/2022] [Indexed: 12/13/2022] Open
Abstract
Background Obstructive sleep apnea is associated with increased lung cancer incidence and mortality. Cancer stem cells (CSCs) are characterized by their self-renewing ability, which contributes to metastasis, recurrence, and drug resistance. ATPase family AAA domain-containing protein 2 (ATAD2) induces malignancy in different types of tumors. However, a correlation between ATAD2 expression and CSCs in lung cancer has not yet been reported. Methods The relative messenger RNA (mRNA) levels of ATAD2, CD44, CD133, and hypoxia-inducible factor (HIF)-1α were determined using reverse-transcription quantitative polymerase chain reaction. ATAD2 protein levels were determined using Western blotting. Cell counting kit-8, 5-ethynyl-2′-deoxyuridine (EdU), and colony formation assays were performed to analyze the proliferation of lung cancer cells. Transwell migration and invasion assays were performed to evaluate cell migration and invasion, respectively. Tumor sphere formation analysis was used to determine tumor spheroid capacity. The link between ATAD2 and HIF-1α was verified using a dual-luciferase reporter assay. Immunofluorescence staining was performed to assess mitochondrial reactive oxygen species (mtROS) production. Flow cytometry analysis was conducted to determine the CD133 and CD44 positive cell ratio. Results We evaluated the relative expression of ATAD2 in four lung cancer cell lines (A549, SPC-A1, H460, and H1299 cells) and found increased mRNA and protein levels of ATAD2 in lung cancer samples. ATAD2 overexpression was a poor prognostic factor for lung cancer patients. Loss of ATAD2 reduced lung cancer cell viability and proliferation. Additionally, ATAD2 knockdown repressed lung cancer cell migration, invasion, stem-cell-like properties, and mtROS production. Chronic intermittent hypoxia (CIH)-induced HIF-1α expression significantly activated ATAD2 during lung cancer progression. Conclusions This study found that CIH induced HIF-1α expression, which acts as a transcriptional activator of ATAD2. The present study also suggests a novel mechanism by which the integrity of CIH-triggered HIF-1α/ATAD2 may determine lung cancer aggressiveness via the interplay of mtROS and stemness in lung cancer cells. Supplementary Information The online version contains supplementary material available at 10.1186/s11658-022-00345-5.
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Affiliation(s)
- Shengyu Hao
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Fan Li
- Department of Nutrition, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Pan Jiang
- Department of Nutrition, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Jian Gao
- Department of Nutrition, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Tan BKJ, Teo YH, Tan NKW, Yap DWT, Sundar R, Lee CH, See A, Toh ST. Association of obstructive sleep apnea and nocturnal hypoxemia with all-cancer incidence and mortality: a systematic review and meta-analysis. J Clin Sleep Med 2022; 18:1427-1440. [PMID: 34755597 PMCID: PMC9059590 DOI: 10.5664/jcsm.9772] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
STUDY OBJECTIVES Biological models suggest that obstructive sleep apnea (OSA) is potentially carcinogenic. We aimed to clarify the inconsistent epidemiological literature by considering various traditional and novel OSA severity indices. METHODS We systematically searched PubMed, Embase, Scopus, and the Cochrane Library for observational or randomized studies of associations of OSA, measured by diagnostic codes or any index, each with all-cancer incidence or mortality in adults, compared with participants with no/mild OSA. Two reviewers independently selected studies, extracted data, and evaluated study bias using the Newcastle-Ottawa scale and quality of evidence using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). We performed inverse variance-weighted, random-effects meta-analyses and sensitivity analyses. RESULTS We included 20 observational studies (5,340,965 participants), all with moderate/low bias, from 1,698 records. Based on T90 (sleep duration with oxygen saturation < 90%), patients with OSA who had moderate (T90 > 1.2%, hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.07-1.54) and severe nocturnal hypoxemia (T90 > 12%, HR = 1.43, 95% CI = 1.16-1.76) experienced 30%-40% higher pooled all-cancer risk than normoxemic patients, after multiple adjustment for covariates including obesity. Furthermore, severe nocturnal hypoxemia nearly tripled all-cancer mortality (HR = 2.66, 95% CI = 1.21-5.85). Patients with apnea-hypopnea index-defined severe OSA, but not moderate OSA, had higher all-cancer risk (HR = 1.18, 95% CI = 1.03-1.35) but similar all-cancer mortality as patients without OSA. An OSA diagnosis was not associated with all-cancer risk. Evidence quality ranged from low to moderate. Insufficient evidence was available on the oxygen desaturation index, lowest/median saturation, and arousal index. CONCLUSIONS In patients with OSA, nocturnal hypoxemia is independently associated with all-cancer risk and mortality. Future studies should explore if risk differs by cancer type, and whether cancer screening and OSA treatment are beneficial. SYSTEMATIC REVIEW REGISTRATION Registry: PROSPERO; URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220836; Identifier: CRD42021220836. CITATION Tan BKJ, Teo YH, Tan NKW, et al. Association of obstructive sleep apnea and nocturnal hypoxemia with all-cancer incidence and mortality: a systematic review and meta-analysis. J Clin Sleep Med. 2022;18(5):1427-1440.
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Affiliation(s)
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicole Kye Wen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Raghav Sundar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Department of Hematology-Oncology, National University Cancer Institute, National University Hospital, Singapore,Cancer and Stem Cell Biology Program, Duke-National University of Singapore Medical School, Singapore,The N.1 Institute for Health, National University of Singapore, Singapore,Singapore Gastric Cancer Consortium
| | - Chi Hang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Department of Cardiology, National University Health System, Singapore
| | - Anna See
- Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Singapore,Surgery Academic Clinical Program, SingHealth, Singapore,Address correspondence to: Song Tar Toh, MBBS, MMed (ORL), MMed (Sleep Medicine), FAMS (ORL), Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore 169608; Tel: +65 6222 3322; ; and Anna See, MBBS, MMed (ORL), Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore 169608; Tel: +65 6222 3322;
| | - Song Tar Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Singapore,Surgery Academic Clinical Program, SingHealth, Singapore,SingHealth Duke-NUS Sleep Centre, SingHealth, Singapore,Address correspondence to: Song Tar Toh, MBBS, MMed (ORL), MMed (Sleep Medicine), FAMS (ORL), Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore 169608; Tel: +65 6222 3322; ; and Anna See, MBBS, MMed (ORL), Department of Otorhinolaryngology–Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore 169608; Tel: +65 6222 3322;
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11
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Lee EJ, Do Han K, Kim SY, Suh JD, Kim JK, Cho JH. Increased incidence of leukemia in patients with obstructive sleep apnea: Results from the national insurance claim data 2007–2014. Sleep Med 2022; 96:113-118. [DOI: 10.1016/j.sleep.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
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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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Porcacchia AS, Ishikura IA, Hachul H, Andersen ML, Tufik S. Does obstructive sleep apnea increase the risk of breast cancer in women during and after menopause? J Clin Sleep Med 2022; 18:961-962. [PMID: 34782064 PMCID: PMC8883108 DOI: 10.5664/jcsm.9784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | | | - Sergio Tufik
- Address correspondence to: Sergio Tufik, MD, PhD, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, Vila Clementino, 04024-002 São Paulo/SP, Brazil; Tel: (55-11) 2149-0160; Fax: (55-11) 5572-5092;
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Markozannes G, Kanellopoulou A, Dimopoulou O, Kosmidis D, Zhang X, Wang L, Theodoratou E, Gill D, Burgess S, Tsilidis KK. Systematic review of Mendelian randomization studies on risk of cancer. BMC Med 2022; 20:41. [PMID: 35105367 PMCID: PMC8809022 DOI: 10.1186/s12916-022-02246-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to map and describe the current state of Mendelian randomization (MR) literature on cancer risk and to identify associations supported by robust evidence. METHODS We searched PubMed and Scopus up to 06/10/2020 for MR studies investigating the association of any genetically predicted risk factor with cancer risk. We categorized the reported associations based on a priori designed levels of evidence supporting a causal association into four categories, namely robust, probable, suggestive, and insufficient, based on the significance and concordance of the main MR analysis results and at least one of the MR-Egger, weighed median, MRPRESSO, and multivariable MR analyses. Associations not presenting any of the aforementioned sensitivity analyses were not graded. RESULTS We included 190 publications reporting on 4667 MR analyses. Most analyses (3200; 68.6%) were not accompanied by any of the assessed sensitivity analyses. Of the 1467 evaluable analyses, 87 (5.9%) were supported by robust, 275 (18.7%) by probable, and 89 (6.1%) by suggestive evidence. The most prominent robust associations were observed for anthropometric indices with risk of breast, kidney, and endometrial cancers; circulating telomere length with risk of kidney, lung, osteosarcoma, skin, thyroid, and hematological cancers; sex steroid hormones and risk of breast and endometrial cancer; and lipids with risk of breast, endometrial, and ovarian cancer. CONCLUSIONS Despite the large amount of research on genetically predicted risk factors for cancer risk, limited associations are supported by robust evidence for causality. Most associations did not present a MR sensitivity analysis and were thus non-evaluable. Future research should focus on more thorough assessment of sensitivity MR analyses and on more transparent reporting.
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Affiliation(s)
- Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Epidemiology and Biostatistics, St. Mary's Campus, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Afroditi Kanellopoulou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | | | - Dimitrios Kosmidis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Xiaomeng Zhang
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Lijuan Wang
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Evropi Theodoratou
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
- CRUK Edinburgh Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, St. Mary's Campus, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Stephen Burgess
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
- Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
- Department of Epidemiology and Biostatistics, St. Mary's Campus, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
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Yap DWT, Tan NKW, Tan BKJ, Teo YH, Tan VKM, See A, Toh ST. The Association of Obstructive Sleep Apnea With Breast Cancer Incidence and Mortality: A Systematic Review and Meta-analysis. J Breast Cancer 2022; 25:149-163. [PMID: 35380020 PMCID: PMC9250875 DOI: 10.4048/jbc.2022.25.e11] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/08/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Emerging evidence from animal models suggests that intermittent hypoxia due to obstructive sleep apnea (OSA) is a risk factor for breast cancer. Despite their biological plausibility, human epidemiological studies have reported conflicting results. Therefore, we conducted a meta-analysis to delineate this relationship. Methods We searched the PubMed, Embase, Scopus, and Cochrane Library databases for eligible studies from inception until June 6, 2021. Two reviewers selected randomized trials or observational studies reporting the association between OSA and breast cancer incidence compared with those without OSA. Two reviewers extracted relevant data and assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and Newcastle-Ottawa Scale (NOS). We pooled the maximally covariate-adjusted hazard ratios (HRs) using a random-effects inverse variance-weighted meta-analysis and performed pre-specified subgroup analyses. Results We included six studies out of 1,707 records, comprising a combined cohort of 5,165,200 patients. All studies used the International Classification of Diseases codes to classify OSA and breast cancer. OSA patients had a 36% increased breast cancer risk (HR, 1.36; 95% confidence interval [CI], 1.03–1.80; N = 6, I2 = 96%) compared to those without OSA. Most studies adjusted for confounders, such as age, sex, obesity, diabetes mellitus, alcohol use, and hypertension. Subgroup analyses for studies with (1) multivariate adjustment and (2) at least five years of follow-up yielded HRs of 1.35 (95% CI, 0.98–1.87; N = 5, I2 = 96%) and 1.57 (95% CI, 1.14–2.18; N = 4; I2 = 90%), respectively. One Mendelian randomization study suggested a causal relationship, with a two-fold increase in the odds of breast cancer in patients with OSA. Conclusion This meta-analysis suggested that OSA is a risk factor for breast cancer. Future studies should explore the dose-response relationship between OSA and breast cancer, and whether treatment may mitigate breast cancer risk or progression.
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Affiliation(s)
- Dominic Wei Ting Yap
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Nicole Kye Wen Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Benjamin Kye Jyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Veronique Kiak Mien Tan
- Department of Breast Surgery, Singapore General Hospital (SGH), Singapore
- Division of Surgery & Surgical Oncology, National Cancer Centre Singapore
- SingHealth Duke-NUS Breast Centre, SingHealth, Singapore
| | - Anna See
- Department of Otorhinolaryngology–Head & Neck Surgery, Singapore General Hospital (SGH), Singapore
| | - Song Tar Toh
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
- Department of Otorhinolaryngology–Head & Neck Surgery, Singapore General Hospital (SGH), Singapore
- SingHealth Duke-NUS Sleep Centre, SingHealth, Singapore
- Duke-NUS Medical School, Singapore
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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:E3237. [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
| | - 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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