Obstructive sleep apnea and nocturnal hypoxemia are associated with an increased risk of lung cancer

Abstract Study Objectives To identify a link between sleep disordered breathing, nocturnal hypoxemia, and lung cancer. Methods We conducted a cross-sectional study of a combined cohort of 302 individuals derived from the sleep apnea in lung cancer study (SAIL; NCT02764866) investigating the prevalence of sleep apnea in lung cancer, and the sleep apnea in lung cancer screening study (SAILS; NCT02764866) investigating the prevalence of sleep apnea in a lung cancer screening program. All subjects had spirometry and a chest CT, underwent home sleep apnea testing (HSAT), and completed a sleep related questionnaire. Subjects from the SAIL study underwent HSAT prior to initiating oncologic therapy or surgery. Subjects with an apnea-hypopnea index (AHI) > 15 were compared with a control group of individuals with an AHI Results The prevalence of sleep apnea and lung cancer in the combined cohort was 42% and 21%, respectively. Lung cancer was 8% more prevalent in patients with an AHI > 15. The difference was statistically significant when assessed by propensity score matching (p=0.015) and nearest neighbor matching (p=0.041). Binary logistic regression adjusted for potential confounders revealed a statistically significant association between AHI (p=0.04), nocturnal hypoxemia, including time spent below 90% oxyhemoglobin saturation (T90%;p=0.005), 3% oxygen desaturation index (ODI3;p=0.02) and lung cancer. Conclusions Sleep apnea and nocturnal hypoxemia are associated with an increased prevalence of lung cancer. Clinical Trial Registration SAIL study (NCT02764866) and SAILS study (NCT02764866)