Impact of moderate-to-severe obstructive sleep apnea on aggressive clinicopathological features of papillary thyroid carcinoma

Abstract

Objective: Obstructive sleep apnea (OSA) may to be strongly associated with cancer mortality. The risk hazards of OSA regarding aggressive features of papillary thyroid carcinoma (PTC) remain unclear. The main objective of this study was to explore the relationship between OSA and aggressive features of PTC.

Methods: We prospectively studied 210 patients (54 men, 156 women; age 43 ± 13 years) with PTC. Indices of sleep respiratory disturbance and oxygen desaturation were determined by polysomnography with the apnea-hypopnea index (AHI) and lowest oxygen saturation (LSaO2), respectively. PTC aggressive features were assessed by postoperative histopathological analysis. Multivariant logistic regression models adjusting for demographic and OSA-related factors were generated to determine OSA risk hazards for aggressive PTC features.

Results: The prevalence of moderate-to-severe OSA (defined as AHI of >15) was 20% in PTC patients. Those in the moderate-to-severe OSA group had higher BMI and more aggressive PTC features. Moderate-to-severe OSA was associated with increased odds of larger tumor size (OR, 4.31; 95% CI, 1.79-10.37; p = 0.001), capsular invasion (OR, 2.96; 95% CI, 1.42-6.16; p = 0.004), multifocality (OR, 3.11; 95% CI, 1.52-6.39; p = 0.002), central (OR, 4.7; 95% CI, 1.77-12.49; p = 0.003) and lateral (OR, 5.94; 95% CI, 2.27-15.54; p < 0.001) cervical lymph node metastasis, and BRAF mutation (OR, 2.88; 95% CI, 1.31-6.31; p = 0.008). Moderate to severe hypoxemia did not correlated with aggressive PTC behaviors.

Conclusions: OSA is a common respiratory disturbance in PTC. Aggressive PTC features in patients with moderate-to-severe OSA implicate OSA as a cause of cancer progression. Respiratory disturbance events have a greater impact on PTC aggressiveness than hypoxia.