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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Obstructive Sleep Apnea and Incident Cancer: A Large Retrospective Multicenter Clinical Cohort Study

Tetyana Kendzerska, Marcus Povitz, Richard S. Leung, Mark I. Boulos, Daniel I. McIsaac, Brian J. Murray, Gregory L. Bryson, Robert Talarico, John F. Hilton, Atul Malhotra and Andrea S. Gershon
Tetyana Kendzerska
1Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada.
2ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada.
3Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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  • ORCID record for Tetyana Kendzerska
  • For correspondence: tkendzerska@toh.ca
Marcus Povitz
4Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
5Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
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Richard S. Leung
6Department of Medicine, the University of Toronto, Toronto, Ontario, Canada.
7St. Michael's Hospital, Toronto, Ontario, Canada.
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Mark I. Boulos
6Department of Medicine, the University of Toronto, Toronto, Ontario, Canada.
8Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Daniel I. McIsaac
2ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada.
3Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
9Departments of Anesthesiology and Pain Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada.
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Brian J. Murray
6Department of Medicine, the University of Toronto, Toronto, Ontario, Canada.
8Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Gregory L. Bryson
3Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
9Departments of Anesthesiology and Pain Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada.
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Robert Talarico
2ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada.
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John F. Hilton
1Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada.
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Atul Malhotra
10Department of Medicine, the University of California, San Diego, California.
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Andrea S. Gershon
2ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada.
6Department of Medicine, the University of Toronto, Toronto, Ontario, Canada.
11Division of Respirology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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DOI: 10.1158/1055-9965.EPI-20-0975 Published February 2021
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Abstract

Background: To examine the association between the severity of obstructive sleep apnea (OSA) and nocturnal hypoxemia with incident cancer.

Methods: This was a multicenter retrospective clinical cohort study using linked clinical and provincial health administrative data on consecutive adults who underwent a diagnostic sleep study between 1994 and 2017 in four academic hospitals (Canada) who were free of cancer at baseline. Cancer status was derived from the Ontario Cancer Registry. Cox cause–specific regressions were utilized to address the objective and to calculate the 10-year absolute risk difference (ARD) in the marginal probability of incident cancer and the number needed to harm (NNH).

Results: Of 33,997 individuals considered, 33,711 with no missing OSA severity were included: median age, 50 years; 58% male; and 23% with severe OSA (apnea-hypopnea index >30). Of the 18,458 individuals with information on sleep time spent with oxygen saturation (SaO2) <90%, 5% spent >30% of sleep with SaO2 <90% (severe nocturnal hypoxemia). Over a median of 7 years, 2,498 of 33,711 (7%) individuals developed cancer, with an incidence rate of 10.3 (10.0–10.8) per 1,000 person-years. Controlling for confounders, severe OSA was associated with a 15% increased hazard of developing cancer compared with no OSA (HR = 1.15, 1.02–1.30; ARD = 1.28%, 0.20–2.37; and NNH = 78). Severe hypoxemia was associated with about 30% increased hazard (HR = 1.32, 1.08–1.61; ARD = 2.38%, 0.47–4.31; and NNH = 42).

Conclusions: In a large cohort of individuals with suspected OSA free of cancer at baseline, the severity of OSA and nocturnal hypoxemia was independently associated with incident cancer.

Impact: These findings suggest the need for more targeted cancer risk awareness in individuals with OSA.

This article is featured in Highlights of This Issue, p. 243

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Cancer Epidemiol Biomarkers Prev 2021;30:295–304

  • Received June 30, 2020.
  • Revision received October 1, 2020.
  • Accepted November 20, 2020.
  • Published first December 2, 2020.
  • ©2020 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 30 (2)
February 2021
Volume 30, Issue 2
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Obstructive Sleep Apnea and Incident Cancer: A Large Retrospective Multicenter Clinical Cohort Study
Tetyana Kendzerska, Marcus Povitz, Richard S. Leung, Mark I. Boulos, Daniel I. McIsaac, Brian J. Murray, Gregory L. Bryson, Robert Talarico, John F. Hilton, Atul Malhotra and Andrea S. Gershon
Cancer Epidemiol Biomarkers Prev February 1 2021 (30) (2) 295-304; DOI: 10.1158/1055-9965.EPI-20-0975

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Obstructive Sleep Apnea and Incident Cancer: A Large Retrospective Multicenter Clinical Cohort Study
Tetyana Kendzerska, Marcus Povitz, Richard S. Leung, Mark I. Boulos, Daniel I. McIsaac, Brian J. Murray, Gregory L. Bryson, Robert Talarico, John F. Hilton, Atul Malhotra and Andrea S. Gershon
Cancer Epidemiol Biomarkers Prev February 1 2021 (30) (2) 295-304; DOI: 10.1158/1055-9965.EPI-20-0975
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