Obstructive sleep apnea is associated with an increased risk for cancer in women, a recent analysis of the European Sleep Apnoea Database study suggests.
“The effect of gender on the association between cancer and OSA has not been adequately addressed in previous studies,” Athanasia Pataka, MD, PhD, from the respiratory failure unit of G. Papanikolaou Hospital in Thessaloniki, Greece, and assistant professor of respiratory medicine at Aristotle University of Thessaloniki, told Healio Pulmonology. “As there is growing evidence that OSA may manifest differently according to gender, with ‘nonclassic’ symptoms in women as fatigue, initial insomnia, depression and morning headaches, clinicians should evaluate more carefully female patients for the detection of possible OSA.”
Researchers examined 19,556 patients aged at least 18 years from the European Sleep Apnoea Database (ESADA) between 2007 and 2016, with OSA assessed via polygraphy or polysomnography. Sleep and anthropometric variables were compared via the Mann-Whitney U test or a t test in patients with and without cancer, and a separate analysis was performed on groups stratified by sex. Adjustments were also made to accommodate for potential confounding variables and cancer risk factors including BMI, age, sex, alcohol use and smoking.
Of the patients studied, 388 (2%) had been diagnosed with prevalent cancer — of whom 1.7% were men and 2.8% were women. Apnea-hypopnea index (AHI) scores of five or more events per hour vs. fewer than five events per hour were significantly associated with a cancer diagnosis (OR = 1.35; 95% CI, 1.02-1.79), particularly among women in the sex-stratified analysis. When patients were stratified by type of sleep study, the association between OSA and cancer in women was significant in patients assessed via polygraphy (AHI 15 vs. < 15 events per hour; OR = 2.23; 95% CI, 1.2-4.14), whereas an association between nocturnal intermittent hypoxia and cancer (OR = 3.01; 95% CI, 1.09-8.32) was present in patients assessed via polysomnography.
“The different cancer prevalence between genders could be explained by the different expression of different cancer subtypes between genders and under conditions of hypoxia or the differences on hormonal influences on tumor cell growth,” Pataka said. “We are planning to evaluate cancer incidence and mortality in our population and to study specific cancer sites and types apart from all cancers combined as the outcome measure.” – by Eamon Dreisbach
Disclosures: Pataka reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.