title: Sleep-disordered breathing and cancer mortality: results from the Wisconsin Sleep Cohort Study.
abstract: BACKGROUND
  Sleep-disordered breathing (SDB) has been associated with total and cardiovascular mortality, but an association with cancer mortality has not been studied. Results from in vitro and animal studies suggest that intermittent hypoxia promotes cancer tumor growth.
  
  
  OBJECTIVE
  The goal of the present study was to examine whether SDB is associated with cancer mortality in a community-based sample.
  
  
  METHODS
  We used 22-year mortality follow-up data from the Wisconsin Sleep Cohort sample (n = 1,522). SDB was assessed at baseline with full polysomnography. SDB was categorized using the apnea-hypopnea index (AHI) and the hypoxemia index (percent sleep time below 90% oxyhemoglobin saturation). The hazards of cancer mortality across levels of SDB severity were compared using crude and multivariate analyses.
  
  
  RESULTS
  Adjusting for age, sex, body mass index, and smoking, SDB was associated with total and cancer mortality in a dose-response fashion. Compared with normal subjects, the adjusted relative hazards of cancer mortality were 1.1 (95% confidence interval [CI], 0.5-2.7) for mild SDB (AHI, 5-14.9), 2.0 (95% CI, 0.7-5.5) for moderate SDB (AHI, 15-29.9), and 4.8 (95% CI, 1.7-13.2) for severe SDB (AHI ≥ 30) (P-trend = 0.0052). For categories of increasing severity of the hypoxemia index, the corresponding relative hazards were 1.6 (95% CI, 0.6-4.4), 2.9 (95% CI, 0.9-9.8), and 8.6 (95% CI, 2.6-28.7).
  
  
  CONCLUSIONS
  Our study suggests that baseline SDB is associated with increased cancer mortality in a community-based sample. Future studies that replicate our findings and look at the association between sleep apnea and survival after cancer diagnosis are needed.
authors.affiliation: Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 615 Walnut Street, WARF Building 707C, Madison, WI 53726, USA. fjnieto@wisc.edu
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Nieto
authors.forename: Paul E
authors.initials: PE
authors.lastname: Peppard
authors.forename: Terry
authors.initials: T
authors.lastname: Young
authors.forename: Laurel
authors.initials: L
authors.lastname: Finn
authors.forename: Khin Mae
authors.initials: KM
authors.lastname: Hla
authors.forename: Ramon
authors.initials: R
authors.lastname: Farré
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D017286:Polysomnography; D016016:Proportional Hazards Models; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D014922:Wisconsin / Q000453:epidemiology