title: Risk of Cancer in Patients with Insomnia, Parasomnia, and Obstructive Sleep Apnea: A Nationwide Nested Case-Control Study.
abstract: OBJECTIVE
  Insomnia, parasomnia, and obstructive sleep apnea have been associated with a number of disease pathologies, but little is known about the relationship of these sleep disorders and cancer. The study explored the risk of sleep disorder (SD)-induced cancer using nationwide population data. Two million data from the National Health Insurance system of Taiwan was used to assess for the relationship.
  
  
  METHODS
  Patients with cancer as our cases and patients without cancer as our control group in 2001-20011. The study patients were traced back to seek the exposure risk factor of sleep disorders, which was divided into three categories: insomnia, obstructive sleep apnea (OSA) and parasomnia. Patients were selected excluding patients who had cancer prior to presenting with the sleep disorder and the person-year is less than 2 years. Each case was randomly matched with two cases with the same age, gender, and index year.
  
  
  RESULTS
  There were significantly increased risks of breast cancer in the patients with insomnia (AHR=1.73; 95% CI: 1.57-1.90), patients with parasomnia (AHR=2.76; 95% CI: 1.53-5.00), and patients with OSA (AHR=2.10; 95% CI: 1.16-3.80). Moreover, patients with parasomnia had significantly higher risk of developing oral cancer (AHR=2.71; 95% CI: 1.02-7.24) compared with patients without parasomnia. The risk of suffering from nasal cancer (AHR=5.96, 95% CI: 2.96-11.99) and prostate cancer (AHR=3.69, 95% CI: 1.98- 6.89) in patients with OSA was significantly higher than that of patients without OSA.
  
  
  CONCLUSIONS
  Our findings provided the evidence that people diagnosed with insomnia, parasomnia and OSA are at a higher risk of developing cancers to remind people to improve sleep quality.
authors.affiliation: 1. Deputy Director, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Hui-Feng
authors.initials: HF
authors.lastname: Fang
authors.affiliation: 2. Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
authors.forename: Nae-Fang
authors.initials: NF
authors.lastname: Miao
authors.affiliation: 3. Assistant, Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chi-Dan
authors.initials: CD
authors.lastname: Chen
authors.affiliation: 4. Nurse, Maternity Department, Emkhuzweni Health Center, Swaziland ; 5. Nurse, Customer Care Officer, Emkhuzweni Health Center, Swaziland.
authors.forename: Trevor
authors.initials: T
authors.lastname: Sithole
authors.affiliation: 6. Associate Professor, School of Nursing, Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
authors.forename: Min-Huey
authors.initials: MH
authors.lastname: Chung
keywords: cancer; insomnia; obstructive sleep apnea; parasomnia