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. 2024 Sep 1;20(9):1415-1422.
doi: 10.5664/jcsm.11170.

Obstructive sleep apnea severity, circulating biomarkers, and cancer risk

A J Hirsch Allen  1 , Tetyana Kendzerska  2 , Parveen Bhatti  3   4 , Rachel Jen  1   5 , Renelle Myers  1   3 , Mohammadreza Hajipour  1 , Stephan F van Eeden  6 , Najib Ayas  1   5   7
Affiliations

Obstructive sleep apnea severity, circulating biomarkers, and cancer risk

A J Hirsch Allen et al. J Clin Sleep Med. .

Abstract

Study objectives: To determine whether obstructive sleep apnea (OSA) severity and/or biomarkers of inflammation/angiogenesis are associated with incident cancer in this clinical cohort.

Methods: Consenting adult patients at the University of British Columbia Hospital between 2003 and 2014 completed a questionnaire about their medical history and sleep habits prior to undergoing a polysomnogram. Blood samples were collected the morning after polysomnography and processed for biomarkers of inflammation and angiogenesis. The clinical, polysomnography, and biomarker data were linked to the British Columbia Cancer Registry to ascertain incident cancer diagnoses. Cox proportional hazard regression was used to assess the association between OSA severity and biomarker concentrations with cancer risk.

Results: A total of 1,990 patients were included in the analysis with a mean follow-up time of 12.8 years; 181 of them (9.1%) developed cancer after polysomnography. OSA severity was significantly associated with cancer risk after controlling for relevant covariates (hazard ratio = 1.08 per 10 events/h apnea-hypopnea index increase, confidence interval = 1.02-1.15, P = .015). In an exploratory analysis, 2 biomarkers were significantly associated with an increased cancer risk after controlling for relevant covariates (hazard ratio per interquartile range pg/mL increase of endostatin = 1.45, confidence interval = 1.12-1.87, P = .01 and hazard ratio for interquartile range pg/mL increase of vascular cell adhesion molecule-1 = 1.48, confidence interval = 1.04-2.11, P = .03, respectively).

Conclusions: OSA severity was an independent risk factor for cancer. Furthermore, 2 circulating markers were significantly associated with cancer risk. If these preliminary findings can be reproduced in other cohorts, biomarkers could potentially be used to prognosticate patients with OSA with respect to cancer risk.

Citation: Hirsch Allen AJ, Kendzerska T, Bhatti P, et al. Obstructive sleep apnea severity, circulating biomarkers, and cancer risk. J Clin Sleep Med. 2024;20(9):1415-1422.

Keywords: apnea-hypopnea index; cancer; obstructive sleep apnea; polysomnography.

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Conflict of interest statement

All the authors of this this manuscript have seen and approved the submission of this manuscript. Work for this manuscript was performed at the University of British Columbia. This study was supported by a VCHRI Investigator Award (Dr. Rachel Jen), a CIHR Team Grant, BC Lung Association Operating Grant, and a MITACS award. The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. The abstract was previously published and presented at ATS 2023 in Washington, DC. The authors report no conflicts of interest.

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