Sleep-disordered Breathing and Cancer Mortality Results from the Wisconsin Sleep Cohort Study
Sleep-disordered Breathing and Cancer Mortality Results from the Wisconsin Sleep Cohort Study
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DOI：
10.1164/rccm.201201-0130oc
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发表时间：
2012-07-15
影响因子：
24.7
通讯作者：
Farre, Ramon
中科院分区：
文献类型：
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作者：
Nieto, F. Javier;Peppard, Paul E.;Farre, Ramon
理由：睡眠呼吸障碍（SDB）与总死亡率和心血管死亡率有关，但与癌症死亡率的关系尚未研究。体外和动物实验结果表明，间歇性缺氧促进肿瘤生长。目的：本研究的目的是在社区样本中检查SDB是否与癌症死亡率相关。方法：我们使用了威斯康星睡眠队列样本（n = 1522） 22年的死亡率随访数据。在基线时用全多导睡眠描记术评估SDB。使用呼吸暂停低通气指数（AHI）和低氧血症指数（睡眠时间低于90%血红蛋白饱和度的百分比）对SDB进行分类。采用粗分析和多变量分析比较不同SDB严重程度的癌症死亡率风险。测量结果和主要结果：调整年龄、性别、体重指数和吸烟后，SDB与总死亡率和癌症死亡率呈剂量-反应关系。与正常受试者相比，轻度SDB （AHI, 5-14.9）的校正相对危险度为1.1(95%可信区间[CI]， 0.5-2.7)，中度SDB （AHI, 15-29.9）的校正相对危险度为2.0(95% CI, 0.7-5.5)，重度SDB （AHI bb0 = 30）的校正相对危险度为4.8 (95% CI, 1.7-13.2) （P-trend = 0.0052）。对于低氧血症指数加重的类别，相应的相对危险度分别为1.6 （95% CI, 0.6-4.4）、2.9 （95% CI, 0.9-9.8）和8.6 （95% CI, 2.6-28.7）。结论：我们的研究表明，基线SOB与社区样本中癌症死亡率增加有关。未来的研究需要复制我们的发现，并研究睡眠呼吸暂停与癌症诊断后生存之间的关系。
Rationale: 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.Objectives: 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.Measurements and Main 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 SOB 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.