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- Title
Obstructive Sleep Apnea and Lung Cancer: A Systematic Review and Meta-Analysis.
- Authors
Jia Yang Cheong, Alex; Kye Jyn Tan, Benjamin; Yao Hao Teo; Kye Wen Tan, Nicole; Wei Ting Yap, Dominic; Ching-Hui Sia; Thun How Ong; Leong Chai Leow; See, Anna; Song Tar Toh; Cheong, Alex Jia Yang; Tan, Benjamin Kye Jyn; Teo, Yao Hao; Tan, Nicole Kye Wen; Yap, Dominic Wei Ting; Sia, Ching-Hui; Ong, Thun How; Leow, Leong Chai; Toh, Song Tar
- Abstract
Rationale: In 2020, lung cancer was the leading cause of cancer deaths and the most common cancer in men. Although obstructive sleep apnea (OSA) has been postulated to be carcinogenic, epidemiological studies are inconclusive. Objectives: To investigate the associations between OSA and the incidence and mortality of lung cancer. Methods: Four electronic databases (PubMed, Embase, Cochrane Library, and Scopus) were searched from inception until 6 June 2021 for randomized controlled trials and observational studies examining the association between sleep apnea and incident lung cancer. Two reviewers selected studies, extracted data, graded the risk of bias using the Newcastle-Ottawa scale and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Random-effects models were used to meta-analyze the maximally covariate-adjusted associations. Results: Seven studies were included in our systematic review, among which four were suitable for meta-analysis, comprising a combined cohort of 4,885,518 patients. Risk of bias was low to moderate. OSA was associated with a higher incidence of lung cancer (hazard ratio, 1.25; 95% confidence interval, 1.02-1.53), with substantial heterogeneity (I2 = 97%). Heterogeneity was eliminated, with a stable pooled effect size, when including the three studies with at least 5 years of median follow-up (hazard ratio, 1.32; 95% confidence interval, 1.27-1.37; I2 = 0%). Conclusions: In this meta-analysis of 4,885,518 patients from four observational studies, patients with OSA had an approximately 30% higher risk of lung cancer compared with those without OSA. We suggest more clinical studies with longer follow-up as well as biological models of lung cancer be performed to further elucidate this relationship.
- Subjects
LUNG cancer; CANCER-related mortality; CANCER in men; SLEEP apnea syndromes; CARCINOGENICITY; EPIDEMIOLOGY
- Publication
Annals of the American Thoracic Society, 2022, Vol 19, Issue 3, p469
- ISSN
2329-6933
- Publication type
journal article
- DOI
10.1513/AnnalsATS.202108-960OC