Obstructive sleep apnea and cancer: a complex relationship

Abstract

Purpose of review Obstructive sleep apnea (OSA) has been recognized as a risk factor for cancer mainly through hypoxia, based on studies that did not distinguish among cancer types. The purpose of this review is to discuss the most recent data on epidemiology and pathophysiology of the OSA–cancer association. Recent findings According to epidemiological studies, OSA may have different influences on each type of cancer, either increasing or decreasing its incidence and aggressiveness. Time spent with oxygen saturation below 90% appears the polysomnographic variable most strongly associated with unfavorable effects on cancer. Experimental studies support the role of hypoxia as an important risk factor for cancer growth and aggressiveness, especially when it shows an intermittent pattern. These effects are largely mediated by the hypoxia-inducible factor, which controls the synthesis of molecules with effects on inflammation, immune surveillance and cell proliferation. Sleep fragmentation participates in increasing cancer risk. Modulating effects of age remain controversial. Summary Effects of OSA on cancer may largely vary among neoplastic diseases, both in their magnitude and direction. The worse risk associated with intermittent rather than persistent hypoxia, and the effects of OSA therapy on cancer natural history are still poorly known, and deserve new careful studies.

The Discovery, Validation, and Function of Hypoxia-Related Gene Biomarkers for Obstructive Sleep Apnea

“…Of note, AREG, ATF3, DUSP1 , and ZFP36 were all related to cancers or pathways in cancer, and numerous studies have reported a role for these genes in different tumors ( 51 – 54 ). OSA is a recognized risk factor for cancer, mainly through hypoxia ( 55 ), but the exact mechanisms remain unclear. Combined with findings from our current study, we speculate that AREG, ATF3, DUSP1 , and ZFP36 may serve as a bridge between cancer and OSA.…”

MicroRNA Sequencing Analysis in Obstructive Sleep Apnea and Depression: Anti-Oxidant and MAOA-Inhibiting Effects of miR-15b-5p and miR-92b-3p through Targeting PTGS1-NF-κB-SP1 Signaling

“…Accordingly, recent studies have shown that OSA may exacerbate vascular senescence via oxidative stress-related pathways through exosomes, accelerate chromosomal aging as evidenced by shortened telomere length, and trigger a senescence-like phenotype in pre-adipocytes [ 35 , 36 , 37 , 38 ]. Abnormal activity of the core cell-cycle machinery represents a driving force of tumorigenesis, while OSA has been recognized as a risk factor for cancer growth and aggressiveness mainly through HIF-1α signaling, which controls the synthesis of molecules with effects on inflammation, immune surveillance, and cell proliferation [ 39 ]. OSA is independently associated with impaired endothelial function and atherosclerosis through inflammation, oxidative stress, autonomic nervous system activation, and platelet activation [ 40 , 41 ].…”

Brazilian Thoracic Association Consensus on Sleep-disordered Breathing

“…(76) Recentemente a associação da AOS com câncer tem sido estudada, sendo que a gravidade da AOS e da hipoxemia noturna intermitente têm sido associadas a maior crescimento tumoral e agressividade, notadamente no melanoma. (77,78)…”