Sleep apnoea and cancer: current insights and future perspectives

Martínez‐García, Miguel Ángel; Campos‐Rodríguez, Francisco; Farré, Ramón

doi:10.1183/09031936.00127912

Cited by 24 publications

(13 citation statements)

References 32 publications

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“…There are various pathophysiological mechanisms that link intermittent hypoxaemia and the formation or spread of cancer, particularly via key intermediate molecules in this process, such as hypoxia-inducible factor-1, a carcinogenesis-related molecule, and vascular endothelial growth factor, which promotes neovascularisation of the tumour and, therefore, its expansion [2,3,19]. According to this hypothesis, several studies in both animals and humans have shown that the presence of intermittent hypoxaemia (sometimes related to sleep apnoea) is associated with increased tumour growth [5], or higher cancer incidence [7] and mortality [8,9], in both population and clinical series.…”

Section: Discussionmentioning

confidence: 99%

Association between sleep disordered breathing and aggressiveness markers of malignant cutaneous melanoma

et al. 2014

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Some recent studies have shown an association between sleep disordered breathing (SDB) and cancer mortality and incidence but no study has focused on a specific type of cancer. The objective of this study was to analyse the relationship between the severity of SDB and factors related to cutaneous malignant melanoma (CMM) aggressiveness.We performed a multicentre observational study in 82 consecutive patients diagnosed with CMM. 56 patients in whom melanoma measurements were available were finally included in the study. Melanoma measurements of aggressiveness included: tumour mitotic rate, Breslow index, presence of ulceration, stage of disease and growth rate of melanoma. A sleep study was performed in all the included patients. Multivariate analyses were used to examine the independent relationship between SDB severity (apnoeahypopnea index (AHI) and nocturnal oxygen desaturation indexes (ODI3% and ODI4%)) and measures of CMM aggressiveness.60.7% of patients had SDB (AHI o5) and 14.3% severe obstructive sleep apnoea (AHI o30). In fully adjusted multivariate analyses, AHI (OR 1.08, 95% CI 1.02-1.14), ODI3% (OR 1.08, 95% CI 1.02-1.11) and ODI4% (OR 1.1, 95% CI 1.02-1.2) were independently associated with an increased melanoma growth rate. Furthermore, AHI, ODI4% and ODI3% were significantly correlated with other aggressiveness factors of CMM, such as Breslow index, presence of ulceration and mitotic index.SDB severity markers are associated with some aggressiveness markers of CMM.@ERSpublications This study adds evidence on the relationship between sleep disordered breathing and cancer aggressiveness

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Section: Discussionmentioning

confidence: 99%

Association between sleep disordered breathing and aggressiveness markers of malignant cutaneous melanoma

et al. 2014

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“…Although the impact of untreated OSA on the outcome of the cancer itself in human subjects has not been well defined, intermittent hypoxia associated with repetitive episodes of reduction or cessation of breathing during sleep can have additional potential adverse consequences at both tissue and systemic levels [26]. Two large observational studies have also suggested the possible effect of intermittent hypoxia and cancer by showing an association between a worse outcome of patients with malignancies and OSA and an increased risk of cancer and OSA.…”

Section: Discussionmentioning

confidence: 99%

Sleep-Related Breathing Disorders in Patients With Tumors in the Head and Neck Region

Faiz

Balachandran

Hessel³

et al. 2014

The Oncologist

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Background. Sleep disturbance is a prominent complaint of cancer patients. Most studies have focused on insomnia and cancer-related fatigue. Obstructive sleep apnea (OSA) has been reported in small studies and case reports. Methods. In a retrospective review of patients who underwent formal sleep evaluation and polysomnography (PSG) from 2006 to 2011, 56 patients with tumors in the head and neck region were identified. Clinical characteristics, sleep-related history, and PSG data were reviewed. Results. Most patients had active cancer (80%), and the majority had squamous pathology (68%). Prominent symptoms included daytime fatigue (93%), daytime sleepiness (89%), and snoring (82%). Comorbid conditions primarily included hypertension (46%) and hypothyroidism (34%). Significant sleeprelated breathing disorder was noted in 93% of patients, and 84% met clinical criteria for OSA. A male predominance (77%) was noted, and patients were not obese (body mass index ,30 kg/m 2 in 52%).The majority of patients (79%) underwent radiation prior to sleep study, of which 88% had OSA, and in the

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“…As a pathogenic mechanism to justify the increased risk of cancer of any origin in these patients, it has been suggested that hypoxia‐induced immune deregulation may compromise the immune surveillance system and favour the escape and progression of cancer cells . Interestingly, several reports using intermittent hypoxia (IH) mouse models support the development of altered polarization of adipose tissue macrophages and altered CD8 + T cells .…”

Section: Introductionmentioning

confidence: 99%

Age‐dependent hypoxia‐induced PD‐L1 upregulation in patients with obstructive sleep apnoea

Cubillos‐Zapata

Balbás-García²,

Avendaño-Ortíz³

et al. 2019

Respirology

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Background and objective: In obstructive sleep apnoea (OSA), intermittent hypoxia (IH) compromises immune surveillance through the upregulation of the programmed cell death-1 (PD-1) receptor and its ligand (PD-L1). Because the risk of OSA-related cancer depends on age, we assessed PD-L1/PD-1 expression in middle-aged and older patients with OSA as well as in a murine model. Methods: PD-L1 expression was studied in 41 patients with severe OSA and 40 healthy volunteers (HV), divided into two groups (≤55 and >55 years of age). We used flow cytometry, quantitative PCR (qPCR) and ELISA to determine PD-L1 expression on monocytes and plasma PD-L1 protein levels. Moreover, we analysed PD-L1 expression on an in vivo IH model with old and young mice. Results: In subjects up to 55 years of age, severe OSA increased PD-L1 surface protein and mRNA level expression on monocytes and soluble-PD-L1 protein concentration in plasma compared to HV. PD-L1 and hypoxia-induced factor (HIF)-1α expression correlated with age in HV, whereas in patients with OSA there was a negative relationship. In the mice exposed to IH, PD-L1 expression on F4/80+ splenocytes was also only increased in young animals. HIF-1α expression was significantly higher in patients with OSA than in HV in subjects up to 55 years of age, while PD-L1 expression in monocytes was related to HIF-1α expression in young patients with OSA. Conclusion: PD-L1 upregulation in patients with OSA as a consequence of HIF-1α activation occurs mainly in young patients. In older patients with OSA, upregulation was not detected, possibly due to impaired oxygen sensitivity. RESULTS Study subjectsForty-one patients with severe OSA were prospectively recruited, including 21 young patients (age < 55 years)Respirology (2019) 24, 684-692Age-dependent PD-L1 upregulation in OSA † † P < 0.01 versus HV younger than 55 years. ‡ ‡ P < 0.01 versus HV older than 55 years. § § P < 0.05 versus patients with OSA older than 55 years. AHI, apnoea-hypopnoea index; FEV 1 , forced expiratory volume at 1 s; FVC, forced vital capacity; HDL, high-density lipoprotein; HV, healthy volunteer; LDL, low-density lipoprotein; OSA, obstructive sleep apnoea; SpO 2 , oxyhaemoglobin saturation.

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Sleep apnoea and cancer: current insights and future perspectives

Cited by 24 publications

References 32 publications

Association between sleep disordered breathing and aggressiveness markers of malignant cutaneous melanoma

Association between sleep disordered breathing and aggressiveness markers of malignant cutaneous melanoma

Sleep-Related Breathing Disorders in Patients With Tumors in the Head and Neck Region

Age‐dependent hypoxia‐induced PD‐L1 upregulation in patients with obstructive sleep apnoea

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