The Association of Obstructive Sleep Apnea With Breast Cancer Incidence and Mortality: A Systematic Review and Meta-analysis

Dominic Wei Ting Yap; Nicole Kye Wen Tan; Benjamin Kye Jyn Tan; Yao Hao Teo; Veronique Kiak Mien Tan; Anna See; Song Tar Toh

doi:10.4048/jbc.2022.25.e11

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자료유형: 학술저널

저자정보: Dominic Wei Ting Yap (Yong Loo Lin School of Medicine National University of Singapore (NUS) Singapore.) Nicole Kye Wen Tan (Yong Loo Lin School of Medicine National University of Singapore (NUS) Singapore.) Benjamin Kye Jyn Tan (Yong Loo Lin School of Medicine National University of Singapore (NUS) Singapore.) Yao Hao Teo (Yong Loo Lin School of Medicine National University of Singapore (NUS) Singapore.) Veronique Kiak Mien Tan (Department of Breast Surgery Singapore General Hospital (SGH) Singapore.Division of Surgery) Anna See (Department of Otorhinolaryngology–Head) Song Tar Toh (Yong Loo Lin School of Medicine National University of Singapore (NUS) Singapore.Department of Otor)

저널정보: 한국유방암학회 Journal of Breast Cancer Journal of Breast Cancer Vol.25 No.3

발행연도: 2022.6

수록면: 149 - 163 (15page)

DOI: 10.4048/jbc.2022.25.e11

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Purpose: Emerging evidence from animal models suggests that intermittent hypoxia due to obstructive sleep apnea (OSA) is a risk factor for breast cancer. Despite their biological plausibility, human epidemiological studies have reported conflicting results. Therefore, we conducted a meta-analysis to delineate this relationship. Methods: We searched the PubMed, Embase, Scopus, and Cochrane Library databases for eligible studies from inception until June 6, 2021. Two reviewers selected randomized trials or observational studies reporting the association between OSA and breast cancer incidence compared with those without OSA. Two reviewers extracted relevant data and assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and Newcastle-Ottawa Scale (NOS). We pooled the maximally covariate-adjusted hazard ratios (HRs) using a random-effects inverse variance-weighted meta-analysis and performed pre-specified subgroup analyses. Results: We included six studies out of 1,707 records, comprising a combined cohort of 5,165,200 patients. All studies used the International Classification of Diseases codes to classify OSA and breast cancer. OSA patients had a 36% increased breast cancer risk (HR, 1.36; 95% confidence interval [CI], 1.03?1.80; N = 6, I2 = 96%) compared to those without OSA. Most studies adjusted for confounders, such as age, sex, obesity, diabetes mellitus, alcohol use, and hypertension. Subgroup analyses for studies with (1) multivariate adjustment and (2) at least five years of follow-up yielded HRs of 1.35 (95% CI, 0.98?1.87; N = 5, I2 = 96%) and 1.57 (95% CI, 1.14?2.18; N = 4; I2 = 90%), respectively. One Mendelian randomization study suggested a causal relationship, with a two-fold increase in the odds of breast cancer in patients with OSA. Conclusion: This meta-analysis suggested that OSA is a risk factor for breast cancer. Future studies should explore the dose-response relationship between OSA and breast cancer, and whether treatment may mitigate breast cancer risk or progression.

#Breast Neoplasms #Hypoxia #Incidence #Mortality #Sleep Apnea #Obstructive

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