阻塞性睡眠呼吸暂停严重程度和癌症相关死亡率的相关性研究

2021-11-19 刘少飞 MedSci原创

OSA 的存在可能会增加癌症发展和较差癌症预后的风险。

在过去的 50-75 年中,睡眠障碍已成为非常普遍的疾病。随着对此类疾病的了解加深,睡眠结构和连续性的扰动可能引发、加剧或调节包括癌症在内的多种疾病的表型表达的认识越来越受到关注。此外,伴随睡眠呼吸障碍的间歇性缺氧,最近与癌症的发病率增加和更不利的预后有关。与睡眠障碍在全球范围内日益流行的同时,大量研究揭示了睡眠与影响几乎所有器官系统的疾病之间的潜在关联。作为此类趋势的一部分,过去 15 年来,人们越来越意识到睡眠持续时间和昼夜节律紊乱可能在流行病学上与患癌症的风险增加或促进不良癌症结果有关。此外,最近在一般睡眠呼吸障碍的背景下出现了类似的推论,更具体地说,与阻塞性睡眠呼吸暂停综合征 (OSAS) 相关,其中 OSAS 的两个主要组成部分,即间歇性缺氧(IH) 和睡眠碎片化 (SF) 可能会导致癌症流行病学和结果的改变。然而,癌症存活率与阻塞性睡眠呼吸暂停 (OSA) 之间关联的证据仍未得到充分探索。

研究目的:

评估 OSA 严重程度标志物(呼吸障碍、低氧血症和睡眠片段化)与既往诊断为癌症的个体的癌症相关死亡率之间的关联。

研究方法:

我们使用关联的临床和省级卫生行政数据对 1994 年至 2017 年间在加拿大四家学术医院接受诊断性睡眠研究并且之前通过安大略癌症登记处被诊断出患有癌症的连续成年人进行了一项多中心回顾性队列研究。多变量原因特定的 Cox 回归被用来解决研究目标。

研究结果:

我们纳入了 2,222 名受试者。在 5.6 年的中位随访时间(IQR:2.7-9.1)中,261/2,222 (11.7%) 名癌症患者死于癌症相关原因,占全因的 44.2% (261/590)死亡。控制年龄、性别、酒精使用障碍、既往心力衰竭、COPD、高血压、糖尿病、OSA 治疗、诊所地点、睡眠研究年份和癌症诊断后的时间、低氧血症和睡眠片段化的测量,但不包括呼吸暂停- 低通气指数与癌症特异性死亡率显着相关:SaO2 <90% 的时间百分比(每增加 5% 的 HR:1.05;95% CI:1.01-1.09);平均 SaO2(HR 每增加 3%:0.79;0.68-0.92);和第一阶段睡眠的百分比(每增加 16% 的 HR:1.27;1.07-1.51)。

研究结论:

在一项由疑似 OSA 和既往诊断为癌症的成人组成的大型临床队列中,夜间低氧血症和睡眠片段化作为 OSA 严重程度的标志物与癌症相关死亡率显着相关,这表明需要更有针对性的风险意识。

睡眠持续时间、睡眠连续性和 OSAS 可能导致癌症流行病学特征的可能机制(图)。

Obstructive sleep apnea and cancer: Epidemiologic links and theoretical  biological constructs. - Abstract - Europe PMC

研究启示:

1).慢性睡眠碎片化和间歇性缺氧(OSAS 的标志性特征)之间的联系在生物学上是合理的,并且描述了几种推定的机制。
2).OSA 的存在可能会增加癌症发展和较差癌症预后的风险。
3).目前尚不清楚对睡眠障碍和 OSAS 进行适当治疗是否会降低恶性肿瘤发病率和不良后果的风险。

参考文献:

Kendzerska T, Gershon AS, Povitz M, Boulos MI, Murray BJ, McIsaac DI, Bryson GL, Talarico R, Hilton J, Malhotra A, Leung RS. Polysomnographic Markers of Obstructive Sleep Apnea Severity and Cancer-Related Mortality: A Large Retrospective Multicenter Clinical Cohort Study. Ann Am Thorac Soc. 2021 Nov 17. doi: 10.1513/AnnalsATS.202106-738OC. Epub ahead of print. PMID: 34788198.

Gozal D, Farré R, Nieto FJ. Obstructive sleep apnea and cancer: Epidemiologic links and theoretical biological constructs. Sleep Med Rev. 2016 Jun;27:43-55. doi: 10.1016/j.smrv.2015.05.006. Epub 2015 Jun 3. PMID: 26447849; PMCID: PMC5374514.

 

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    2022-07-02 tomyang96
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    2021-11-20 moyanju2796

    学习到了。

    1

    展开1条回复
  6. [GetPortalCommentsPageByObjectIdResponse(id=1838006, encodeId=8626183800677, content=<a href='/topic/show?id=3f34e253206' target=_blank style='color:#2F92EE;'>#相关性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72532, encryptionId=3f34e253206, topicName=相关性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Mon Jun 20 17:21:35 CST 2022, time=2022-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1989189, encodeId=ab661989189c0, content=<a href='/topic/show?id=246ee29858f' target=_blank style='color:#2F92EE;'>#睡眠呼吸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72985, encryptionId=246ee29858f, topicName=睡眠呼吸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3138208, createdName=zhanfl, createdTime=Tue Feb 01 15:21:35 CST 2022, time=2022-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696992, encodeId=91ae1696992b8, content=<a href='/topic/show?id=d2e99e651e4' target=_blank style='color:#2F92EE;'>#阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97651, encryptionId=d2e99e651e4, topicName=阻塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a23129903429, createdName=tomyang96, createdTime=Sat Jul 02 07:21:35 CST 2022, time=2022-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1953189, encodeId=e1ec19531895e, content=<a href='/topic/show?id=d441e1440e8' target=_blank style='color:#2F92EE;'>#癌症相关#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71440, encryptionId=d441e1440e8, topicName=癌症相关)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Thu Jan 20 17:21:35 CST 2022, time=2022-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1071995, encodeId=05e710e19956f, content=学习到了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cbcd5675699, createdName=moyanju2796, createdTime=Sat Nov 20 08:40:00 CST 2021, time=2021-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1596628, encodeId=377915966287e, content=<a href='/topic/show?id=70e4396491a' target=_blank style='color:#2F92EE;'>#呼吸暂停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39649, encryptionId=70e4396491a, topicName=呼吸暂停)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e2a518392360, createdName=119337463, createdTime=Sat Nov 20 16:21:35 CST 2021, time=2021-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1071984, encodeId=dbe910e198490, content=长津湖免费观影第二波,明天11月20日,10:00的场次,明天开场前在建邺影城取票,只有100个名额哈, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Sat Nov 20 07:59:08 CST 2021, time=2021-11-20, status=1, ipAttribution=)]
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    2021-11-20 查查佳佳

    长津湖免费观影第二波,明天11月20日,10:00的场次,明天开场前在建邺影城取票,只有100个名额哈

    0

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