Obstructive Sleep Apnea and Cancer Burden: Impact of Apnea Severity and Treatment

项目总结/摘要 阻塞性睡眠呼吸暂停（OSA）影响美国约1800万至2200万成年人。为 随着肥胖症的流行，OSA的患病率持续增加，我们对 阻塞性睡眠呼吸暂停综合征对健康的深远影响，包括高血压、心脏病、 中风、糖尿病、职业伤害、机动车伤害和总体死亡率。最近，证据 提示与OSA相关的另一个重要疾病负担已经开始出现： 癌症发病率和癌症死亡率。鉴于阻塞性睡眠呼吸暂停综合征是一种高度可治疗的疾病，这些证据表明， 这是预防癌症的一个重要机会。然而，很少有流行病学研究探讨了 OSA和癌症之间可能存在联系，迄今为止，还没有研究评估OSA治疗的影响 癌症发病率。本项目的目的是评估阻塞性睡眠呼吸暂停与 癌症发病率和生存率，特别关注阻塞性睡眠呼吸暂停严重程度的影响， 癌症发病率的治疗。在目标1中，我们将描述OSA的严重程度， 诊断睡眠研究期间记录的五项临床测量结果与癌症发病率有关（1a） 以及癌症存活和预后肿瘤特征（1b）。在目标2中，我们将研究 持续气道正压通气（CPAP）治疗OSA的使用，以及CPAP治疗依从性， 癌症发病率（2a）和癌症存活率（2b）。为了实现这些目标，该项目有效地利用了 华盛顿大学（UW）睡眠中心的医疗记录与 监测，流行病学和最终结果（SEER）癌症登记处服务于西华盛顿州。 在这种联系的基础上，将对15，000名以上患者的一个子集进行详细的病历审查 2005-2011年间在UW睡眠中心被诊断患有OSA，包括所有被诊断患有OSA的患者。 在被诊断患有OSA之后的癌症（N~920）和未被诊断患有癌症的OSA患者的子集 （N~720）。通过这种详细的医疗记录审查和从电子医疗记录中提取数据， 将收集有关人口统计学因素、合并症、体重指数和吸烟史的信息， 以及在OSA诊断时收集的OSA严重程度的测量，以及CPAP使用的指标， 在UW睡眠中心随访时收集的依从性。SEER中的癌症属性信息 如肿瘤部位和癌症诊断时的分期，将有助于进一步的详细分析。本研究 将标志着一个最大的，最全面的调查之间的关系OSA和 癌症至今知情的干预措施，以改善OSA的诊断，并鼓励适当的OSA治疗 可以为降低癌症发病率和提高癌症存活率提供一种有效的方法。见解 因此，通过这项新的研究获得的信息可以激发小学、中学和高等教育的重要机会。 通过OSA筛查和治疗预防癌症发病率和死亡率。

PROJECT SUMMARY / ABSTRACT Obstructive sleep apnea (OSA) affects approximately 18 to 22 million adults in the United States. As the prevalence of OSA continues to increase with the growing obesity epidemic, so too has our understanding of the far-reaching health consequences of OSA, including an increased risk of hypertension, heart disease, stroke, diabetes, occupational injuries, motor vehicle injuries, and overall mortality. Recently, evidence suggestive of yet another important disease burden associated with OSA has begun to emerge: increased risk of incident cancer and cancer mortality. Given that OSA is a highly treatable condition, such evidence suggests an important opportunity for cancer prevention. Few epidemiologic studies, however, have explored the possible link between OSA and cancer, and no studies, to date, have assessed the impact of OSA treatment on cancer rates. The objective of this project is to evaluate the relationship of obstructive sleep apnea with cancer incidence and survival, placing particular focus on the impact of obstructive sleep apnea severity and treatment on cancer rates. In Aim 1, we will characterize ways in which the severity of OSA, captured in the form of five clinical measurements recorded during diagnostic sleep studies, relates to cancer incidence (1a) and to cancer survival and prognostic tumor characteristics (1b). In Aim 2, we will examine the association of continuous positive airway pressure (CPAP) treatment use for OSA, and CPAP treatment compliance, with cancer incidence (2a) and cancer survival (2b). In pursuit of these Aims, this project efficiently leverages an ongoing linkage between medical records from the University of Washington (UW) Sleep Center and the Surveillance, Epidemiology, and End Results (SEER) cancer registry serving western Washington State. Building on this linkage, detailed medical record review will be conducted on a subset of the >15,000 patients diagnosed with OSA at the UW Sleep Center between 2005-2011, including all such patients diagnosed with cancer after being diagnosed with OSA (N~920) and a subset of OSA patients not diagnosed with cancer (N~720). Through this detailed medical record review and by extracting data from electronic medical records, information will be collected on demographic factors, comorbidities, body mass index, and smoking history, as well as measures of OSA severity collected at the time of OSA diagnosis, and indicators of CPAP use and compliance collected at UW Sleep Center follow-up visits. Information on cancer attributes from the SEER registry, such as tumor site and stage at cancer diagnosis, will facilitate further detailed analyses. This study will mark one of the largest, and the most comprehensive investigation into the relationship between OSA and cancer to date. Informed interventions to improve the diagnosis of OSA and encourage proper OSA treatment could provide an efficient approach to reducing cancer incidence and improving cancer survival. Insights gained through this novel study could thus motivate important opportunities for primary, secondary, and tertiary prevention of cancer morbidity and death through OSA screening and treatment.