首度發現睡眠呼吸中止與癌症死亡率有關


  【24drs.com】研究者在美國胸腔科協會2012國際研討會中報告指出,在一篇追蹤超過1,500名威斯康辛州雇員達20年以上的研究中,睡眠呼吸中止—特別是嚴重者—與死於癌症風險大幅增加有關。
  
  這篇研究中,當研究者使用睡眠呼吸暫停低通氣指數分類睡眠異常呼吸時,嚴重睡眠呼吸中止者的癌症死亡率相對風險為4.8 (95%信心區間1.7-13.2;P= .0052)。當研究者計算低血氧指數(血氧飽和濃度低於90%的時間百分比)時,癌症死亡率相對風險介於中度睡眠呼吸中止者的2.9到嚴重睡眠呼吸中止者的8.6。
  
  美國威斯康辛大學醫學和公衛學院人口健康科學系主任F.Javier Nieto博士表示,這是第一篇顯示睡眠呼吸中止和癌症死亡風險增加有關的研究。
  
  研究者解釋,慢性缺氧或氧氣供應不足,在實驗室研究中,都與癌症治療的阻抗性及腫瘤病程有關,因此,這些研究結果有其道理。
  
  該研究分析的1,522名州雇員中,365人(24%)有輕微的睡眠呼吸中止、59人(4%)有嚴重睡眠呼吸中止;研究者將9名使用連續陽壓(CPAP)機器治療睡眠呼吸中止的病患納入分析。他們指出,使用CPAP最可能是最近發生睡眠呼吸中止的適應症。當研究者排除這些使用CPAP治療者時,睡眠呼吸中止和癌症死亡的關聯依舊。
  
  研究對象完成了有關教育程度、一般健康狀態、體能活動、身體質量指數、糖尿病診斷、日間睡眠情況的問卷。他們指出,癌症死亡風險增加和睡眠呼吸中止之間的關聯,與肥胖及日間睡眠無關。
  
  Nieto博士表示,追蹤22年之後,威斯康辛世代有112例死亡,其中50例可歸因於癌症;最常見的癌症死因為肺癌,其他則是大腸直腸癌、子宮內膜癌、卵巢癌、腦癌、乳癌、膀胱癌、肝癌。
  
  這個世代中,31例癌症死亡發生於沒有睡眠呼吸中止者,19例發生於輕微、中度或嚴重睡眠呼吸中止者。
  
  Nieto博士表示,研究的下一步是釐清睡眠呼吸中止是否增加癌症風險,或者這問題是當你有睡眠呼吸中止且有癌症診斷時,存活會比較不確定。
  
  Nieto博士指出,CPAP治療可能可以改善癌症或癌症死亡風險,但它是不可能的,這個假設應被檢測。不過做這類研究是不道德的,因為暫停CPAP治療將使你可能有健康風險,包括在開車時睡著。
  
  史丹佛睡眠醫學中心醫學主任Clete Kushida博士表示,這篇有關睡眠呼吸中止和癌症死亡率的研究非常有趣。 不過,除了癌症案例數少,這篇研究還有一些限制:研究者未探討睡眠品質的影響。
  
  他問道,會不會實際上是缺氧、或睡眠質量中斷才是癌症死亡的風險因素?他表示,當你睡眠中斷時,會導致睡眠剝奪,這可能是身體的明顯壓力源。
  
  底線是,我們需要更多研究與進一步分析。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6833&x_classno=0&x_chkdelpoint=Y
  

Sleep Apnea Linked to Cancer Mortality for the First Time

By Barbara Boughton
Medscape Medical News

May 25, 2012 (San Francisco, California) — In a study that followed more than 1500 state employees in Wisconsin for more than 20 years, sleep apnea — particularly if it was severe — was found to be associated with a greatly increased risk for death from cancer, researchers reported here at the American Thoracic Society 2012 International Conference.

In the study, those with severe sleep apnea had a relative risk for cancer mortality of 4.8 (95% confidence interval, 1.7 to 13.2; P = .0052) when the researchers used the apnea-hypopnea index to classify sleep-disordered breathing. When the researchers calculated hypoxemia index (the percent of time below 90% oxyhemoglobin saturation), the relative risk for cancer mortality ranged from 2.9 for those with moderate sleep apnea to 8.6 for those with severe sleep apnea.

"This is the first study to show that sleep apnea is related to increased risk of cancer death," said lead researcher F. Javier Nieto, MD, PhD, chair of the Department of Population Health Sciences at the University of Wisconsin School of Medicine and Public Health in Madison.

Chronic hypoxia, or inadequate supply of oxygen, has been associated with both therapeutic resistance to cancer therapies and tumor progression in laboratory studies, so these findings make sense, the researchers explain.

Of the 1522 state employees assessed in the study, 365 (24%) had at least mild sleep apnea and 59 (4%) had severe sleep apnea. The researchers included 9 subjects who used continuous positive air pressure (CPAP) machines — a common sleep apnea treatment — in their analysis. They noted that the use of CPAP was most likely an indication of recent sleep apnea. The association between sleep apnea and cancer death remained when the researchers removed those treated with CPAP.

Subjects completed questionnaires on educational level, general health, physical activity, body mass index, diabetes diagnoses, and daytime sleepiness. The link between increased risk for cancer death and sleep apnea was independent of obesity and daytime sleepiness, they note.

After 22 years of follow-up, there were 112 deaths in the Wisconsin cohort, 50 of which could be attributed to cancer, Dr. Nieto said.

The most common cause of cancer death was lung cancer, but deaths were also attributed to colorectal, endometrial, ovarian, brain, breast, bladder, and liver cancer.

In the cohort, 31 cancer deaths occurred in those without sleep apnea and 19 in those with mild, moderate, or severe sleep apnea.

"The next step in our research is to find out whether sleep apnea increases the risk for cancer or whether the problem is that when you have apnea and are diagnosed with cancer, your survival is less certain," Dr. Nieto said.

Dr. Nieto noted that it is possible that CPAP treatment ameliorates the risk for cancer or cancer death, but it is unlikely that this hypothesis would ever be tested. "It would be unethical to do such a study because withholding CPAP treatment would subject you to a range of health risks, including falling asleep while driving," he said.

"This study on sleep apnea and cancer mortality is very intriguing," said Clete Kushida, MD, PhD, professor and medical director of the Stanford Sleep Medicine Center in Palo Alto, California.

However, in addition to the small number of cancer cases, this study might have been limited by the fact that the researchers did not look at the impact of sleep quality, Dr. Kushida noted. "Is it really the hypoxia, or is it the disruption in sleep quality that is a risk factor for cancer death?" he asked. "When your sleep is disrupted, it results in sleep deprivation, and that can be a significant stressor on the body," he said.

"The bottom line is that we need more studies and further analyses," Dr. Kushida said.

The study was funded by the National Heart, Lung, and Blood Institute. Dr. Nieto and Dr. Kushida have disclosed no relevant financial relationships.

American Thoracic Society (ATS) 2012 International Conference: Abstract 30627. Presented May 20, 2012.

    
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