These three research reveal disturbing connections between obstructive sleep apnea and severe illnesses that have an impact on survival and quality of life.
People with obstructive sleep apnea (OSA) have a higher chance of developing cancer, says a big study presented today at the European Respiratory Society (ERS) International Congress in Barcelona, Spain.
A second study found that obstructive sleep apnea (OSA) was similarly associated with a decrease in the processing powers of senior people; in particular, those aged 74 years or more and men showed a greater loss in some cognitive assessments. A third study indicated that severe OSA patients were more likely to develop life-threatening blood clots.
People who suffer from obstructive sleep apnea (OSA) cease breathing repeatedly during the night due to a blockage of the airway, either partial or complete. The symptoms of this include daytime tiredness, loud snoring, gasping, and choking. It is estimated that between 7 and 13 percent of the population is affected by it. People who are diabetic, have a high body mass index (BMI), smoke cigarettes or drink excessive amounts of alcohol are more likely to develop obstructive sleep apnea (OSA).
“It is known already that patients with obstructive sleep apnoea have an increased risk of cancer,” says Dr. Andreas Palm, who presented the study, “but it has not been clear whether or not this is due to the OSA itself or to related risk factors for cancer, such as obesity, cardiometabolic disease and lifestyle factors.”
The results say “that oxygen deprivation due to OSA is independently associated with cancer.”
Dr. Palm and his team looked at data from 62,811 people in Sweden who had OSA five years before they started treatment. Continuous positive airway pressure (CPAP), which delivers a positive pressure of air through a mask to keep the airways open while sleeping, was used to treat patients between July 2010 and March 2018. The researchers combined these data with those from Statistics Sweden’s socioeconomic database and the Swedish National Cancer Registry.
The researchers considered variables that might have an impact on the findings, such as socioeconomic status, body size, and other health issues. A control group of 2,093 patients with OSA but no cancer was matched with 2,093 patients with OSA and a cancer diagnosis that had occurred up to five years earlier. The oxygen desaturation index (ODI), which calculates how frequently blood oxygen levels fall by at least 3 percent for ten seconds or longer per hour, or the apnoea hypopnea index (AHI), which counts the amount of breathing disruptions during sleep, were used to assess the severity of OSA.
They “found that patients with cancer had slightly more severe OSA, as measured by an apnoea hypopnea index average of 32 versus 30, and an oxygen desaturation index of 28 versus 26.
“In further analysis of subgroups, ODI was higher in patients with lung cancer (38 versus 27) prostate cancer (28 versus 24) and malignant melanoma (32 versus 25).”
The results of this study show that untreated sleep apnoea should be taken into account as a risk factor for cancer and that doctors should be aware of this possibility when treating OSA patients.
“However, extending screening for cancer to all OSA patients is not justified or recommended by our study results.”
The study only examined data from one moment in time, therefore it is unable to prove that OSA causes cancer; rather, it can only demonstrate that it is related to it. The study did not capture several crucial lifestyle aspects on an individual basis, such as eating preferences and physical activity. The study’s strengths lie in its sizable sample size and the reliability of the cancer and OSA data used in the analysis.
In the second study, conducted by Dr. Nicola Marchi, the team found that OSA was associated with a greater decline in mental processing powers over a five-year period.
People 65 years of age and older from Lausanne’s general population who were enrolled in the CoLaus/PsyCoLaus and HypnoLaus studies between 2003 and 2008 and who were followed up every five years were the subject of a study by Professor Heinzer, Dr. Nicola Marchi of Lausanne University Hospital, and colleagues. When they signed up for the trials, a total of 358 participants had a sleep test to determine whether they had OSA and how severe it was. Their ability to process information was also examined during the initial follow-up between 2009 and 2013, and a new cognitive assessment was performed during the second follow-up five years later.
The cognitive tests evaluated executive function (ability to plan thoughts and activities, set priorities, and make decisions), verbal memory, language, and visual perception of spatial relationships between objects, as well as global cognitive function (knowledge and reasoning skills) (visuospatial function).
The findings revealed “that OSA and, in particular, low oxygen levels during sleep due to OSA, was associated with a greater decline in global cognitive function, processing speed, executive function and verbal memory.”
They “also found that people aged 74 and older and men were at higher risk of cognitive decline related to sleep apnoea in some specific cognitive tests.”
For instance, the verbal fluency test revealed a steeper decline in men only, but not in women, while the Stroop test, which assesses processing speed and executive function, revealed a steeper decline in participants aged 74 and older compared to younger participants.
This study shows that nighttime oxygen deprivation and the degree of sleep apnoea both contribute to cognitive deterioration in old life. Additionally, it demonstrates that sleep apnoea is not associated with a deterioration in all cognitive processes; for example, language and visuospatial function were not impacted, according to Dr. Marchi. These cognitive skills include verbal memory, executive function, and processing speed.
Doctors and patients with OSA should be aware that OSA may contribute to cognitive deterioration. Continuous positive airway pressure (CPAP) therapy for OSA has not, as of yet, been conclusively shown to stop cognitive impairment.
“Our study suggests that probably not all OSA patients have the same risk of cognitive decline; there is probably a subgroup of patients, particularly those with greater nocturnal oxygen deprivation but also older patients and men, who could be at greater risk of OSA-related cognitive decline,” the author adds.
The study’s strengths include the fact that it tracked patients for five years, that OSA was assessed using the “gold standard” polysomnography test, and that numerous tests were utilized to examine a variety of cognitive activities. One limitation is that the people who took part in the study were mostly healthy and didn’t have severe memory loss or dementia. Another problem is that OSA was only tested at the beginning of the study.
More severe OSA, as defined by AHI and markers of nocturnal oxygen deprivation, was associated with an increased risk of venous thromboembolism, according to the findings of a third study reported by Professor Wojciech Trzepizur from Angers University Hospital, France (VTE). 104 VTEs developed in 7,355 patients over six years.
This is the first study to look into the relationship between unprovoked venous thromboembolism incidence and obstructive sleep apnoea. The team found that individuals with blood oxygen levels below 90% of normal for more than 6 percent of the night had a nearly two-fold increased chance of developing VTEs compared to those who did not experience oxygen deprivation, according to Professor Trzepizur.
“Further studies are required to see whether adequate treatment for OSA, for instance with CPAP treatment, might reduce the risk of VTEs in patients with marked nocturnal oxygen deprivation.”
These three research reveal disturbing connections between obstructive sleep apnea and severe illnesses that have an impact on survival and quality of life.
The data show that sleep apnea is crucial for cancer, blood clots, and mental health.
Even though they can’t prove that OSA causes any of these health problems, people should know about these links and try to make changes to their lives, like keeping a healthy weight, to lower their risk of OSA.
If OSA is suspected, a definitive diagnosis and treatment plan should be initiated, according to experts.
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