Association of sleep apnoea and incidence# of malignancy, comparison of existing studies
| First author (year) [ref.] | Population n (% female) | T2D % | Study design | Follow-up years | Sleep apnoea diagnosis | Main outcomes | Main findings | Key limitations |
| Sleep apnoea diagnosis with PSG or PG | ||||||||
| Prospective | ||||||||
| Driendl (2020; present study) | 1239 (41) | 100 | Prospective cohort study | 2.7 | PG | Cancer incidence (n=79) | Association between AHI ≥30 events·h−1 and cancer incidence in females | Use of PG |
| Marshall (2014) [39] | 390 (26) | 3 | Prospective cohort study | 20 | PG | Cancer incidence (n=125) | Association between elevated RDI (≥15 events·h−1) and cancer incidence | Small population Lack of control of some cancer risk factors Lack of information on PAP therapy |
| Retrospective | ||||||||
| Justeau (2020) [40] | 8748 (36) | 15 | Retrospective cohort study, multicentre | 5.8 | PSG, PG | Cancer incidence (n=718) | Association between nocturnal hypoxaemia (tsat90% >13%) and cancer incidence | Lack of control of some cancer risk factors Partial use of PG |
| Campos- Rodriguez (2013) [9] | 4910 (33) | n/s | Retrospective cohort study, multicentre | 4.5 | PSG (32%), PG (68%) | Cancer incidence (n=261) | Association between severe OSA (tsat90% >12%) and cancer incidence, limited to male patients <65 years | Lack of control of some cancer risk factors Major use of PG |
| Brenner (2019) [10] | 5243 (26) | n/s | Retrospective cohort study | 5.9 | PSG | Cancer incidence (n=265) | Association between AHI >57 events·h−1 and cancer incidence for patients <45 years | Lack of control of some cancer risk factors Lack of information on PAP therapy |
| Kendzerska (2014) [41] | 10 149 (38) | 14 | Retrospective cohort study, multicentre | 7.8 | PSG | Cancer incidence (n=627) | No association between OSA and cancer incidence | |
| Cross-sectional | ||||||||
| Pataka (2019) [42] | 19 556 (29) | n/s | Cross-sectional analysis, multicentre | PSG, PG | Cancer prevalence (n=388) | Association between cancer prevalence and OSA and nocturnal hypoxaemia in females | Lack of control of some cancer risk factors Lack of information on PAP therapy | |
| Meta-analysis | ||||||||
| Shantha (2015) [21] | 112 228 (26–100) | 4–22 | Meta-analysis, five studies | 4.5–20 | PSG, PG | Cancer incidence (n=864) | Patients with SDB had a nearly 50% greater overall cancer risk compared with patients without SDB | |
| Zhang (2017) [22] | 86 460 (26–38) | n/s | Meta-analysis, six studies | 4.5–20 | PSG, PG | Cancer incidence (n=965) | OSA was not independently associated with cancer incidence | |
| OSA diagnosed according to ICD-9 or symptoms | ||||||||
| Prospective | ||||||||
| Christensen (2013) [43] | 8783 (55) | n/s | Prospective cohort study | 13 | Symptoms of OSA | Cancer incidence (n=1985) | No association between symptoms of OSA and cancer incidence | OSA diagnosis based on symptoms Lack of information on PAP therapy |
| Retrospective | ||||||||
| Gozal (2016) [11] | 5.6 million (50) | 14 in OSA-group | Retrospective cohort study | 3.2–3.9 | According to ICD-9-CM | Cancer incidence (n=167 022) | Elevated risk for malignant melanoma and kidney and pancreatic cancer for patients with OSA Lower risk for colorectal, breast and prostate cancer for patients with OSA | Potential bias by use of administrative claims database Lack of control of some cancer risk factors |
| Sillah (2018) [12] | 34 402 (43) | n/s | Retrospective cohort study | 5.3 | According to ICD-9-CM | Cancer incidence (n=1575) | Elevated risk for malignant melanoma and kidney, uterine and breast cancer for patients with OSA Lower risk for colorectal and lung cancer for patients with OSA | Lack of control of some cancer risk factors Lack of information on PAP therapy |
T2D: type 2 diabetes mellitus; PSG: polysomnography; PG: polygraphy; OSA: obstructive sleep apnoea; ICD-9-CM: International Classification of Diseases, 9th Revision, Clinical Modification; AHI: apnoea–hypopnoea index; RDI: respiratory disturbance index; n/s: not specified; PAP: positive airway pressure; SDB: sleep disordered breathing; tsat90%: percentage of night-time spent with oxygen saturation <90%. #: prevalence shown for Pataka et al. [42].