title: Obstructive sleep apnea is associated with cancer mortality in younger patients.
abstract: OBJECTIVE
  The association between obstructive sleep apnea (OSA) and cancer mortality has scarcely been studied. The objective of this study was to investigate whether OSA is associated with increased cancer mortality in a large cohort of patients with OSA suspicion.
  
  
  METHODS
  This was a multicenter study in consecutive patients investigated for suspected OSA. OSA severity was measured by the apnea-hypopnea index (AHI) and the hypoxemia index (% night-time spent with oxygen saturation <90%, TSat90). The association between OSA severity and cancer mortality was assessed using Cox's proportional regression analyses after adjusting for relevant confounders.
  
  
  RESULTS
  In all, 5427 patients with median follow-up of 4.5 years were included. Of these, 527 (9.7%) were diagnosed with cancer. Log-transformed TSat90 was independently associated with increased cancer mortality in the entire cohort (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.42), as well as in the group of patients with cancer (HR, 1.19; 95% CI, 1.02-1.41). The closest association was shown in patients <65years in both the AHI (continuous log-transformed AHI: HR, 1.87; 95% CI, 1.1-3.2; upper vs lower AHI tertile: HR, 3.98; 95% CI, 1.14-3.64) and the TSat90 (continuous log-transformed TSat90: HR, 1.73; 95% CI, 1.23-2.4; upper vs. lower TSat90 tertile: HR, 14.4; 95% CI, 1.85-111.6).
  
  
  CONCLUSIONS
  OSA severity was associated with increased cancer mortality, particularly in patients aged <65 years.
authors.affiliation: Respiratory Department, La Fe University and Polytechnic Hospital, Valencia, Spain; CIBER de Enfermedades Respiratorias, Bunyola, Spain. Electronic address: mianmartinezgarcia@gmail.com.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Martínez-García
authors.affiliation: Respiratory Department, Valme University Hospital, Sevilla, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Campos-Rodriguez
authors.affiliation: Alava University Hospital, Vitoria, Spain; CIBER de Enfermedades Respiratorias, Bunyola, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Durán-Cantolla
authors.affiliation: Respiratory Department, Son Espases University Hospital, Palma de Mallorca, Spain; CIBER de Enfermedades Respiratorias, Bunyola, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: de la Peña
authors.affiliation: Respiratory Department, Corporació Sanitaria Parc Tauli Hospital, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Bunyola, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Masdeu
authors.affiliation: Respiratory Department, Marques de Valdecilla Hospital, Santander, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: González
authors.affiliation: Respiratory Department, Rio Hortega Hospital, Valladolid, Spain; CIBER de Enfermedades Respiratorias, Bunyola, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Del Campo
authors.affiliation: Respiratory Unit, Requena General Hospital, Valencia, Spain.
authors.forename: Pablo Catalán
authors.initials: PC
authors.lastname: Serra
authors.affiliation: Respiratory Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Valero-Sánchez
authors.affiliation: Respiratory Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: M J Selma
authors.initials: MJ
authors.lastname: Ferrer
authors.affiliation: Respiratory Department, Miguel Servet Hospital, Zaragoza, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Marín
authors.affiliation: Respiratory Department, Arnau de Vilanova Hospital, IRB, Lleida, Spain; CIBER de Enfermedades Respiratorias, Bunyola, Spain.
authors.forename: Ferrán
authors.initials: F
authors.lastname: Barbé
authors.affiliation: IRB Lleida, Lleida, Spain; CIBER de Enfermedades Respiratorias, Bunyola, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Martínez
authors.affiliation: Facultat de Medicina, Universitat de Barcelona University, IDIBAPS, Spain; CIBER de Enfermedades Respiratorias, Bunyola, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Farré
authors.affiliation: Respiratory Department, Clinic Hospital-IDIBAPS, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Bunyola, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Montserrat
mesh_terms: D000367:Age Factors; D000368:Aged; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy
keywords: Cancer; Intermittent hypoxemia; Mortality; Obstructive sleep apnea; Sleep apnea; Sleep-disordered breathing