Obstructive sleep apnea and the incidence and mortality of gastrointestinal cancers: a systematic review and meta-analysis of 5,120,837 participants

Yao Hao Teo; Benjamin Kye Jyn Tan; Nicole Kye Wen Tan; Dominic Wei Ting Yap; Yi Xuen Chai; Yao Neng Teo; Ching-Hui Sia; Raghav Sundar; Emile Tan; Anna See; Song Tar Toh

doi:10.21037/jgo-22-153

Obstructive sleep apnea and the incidence and mortality of gastrointestinal cancers: a systematic review and meta-analysis of 5,120,837 participants

J Gastrointest Oncol. 2022 Dec;13(6):2789-2798. doi: 10.21037/jgo-22-153.

Authors

Yao Hao Teo^#¹, Benjamin Kye Jyn Tan^#¹, Nicole Kye Wen Tan¹, Dominic Wei Ting Yap¹, Yi Xuen Chai¹, Yao Neng Teo¹, Ching-Hui Sia^{1

2}, Raghav Sundar³, Emile Tan⁴, Anna See^{5

6}, Song Tar Toh^{5

6

7}

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
² Department of Cardiology, National University Health System, Singapore, Singapore.
³ Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.
⁴ Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.
⁵ Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore.
⁶ Surgery Academic Clinical Program, SingHealth, Singapore, Singapore.
⁷ Duke-NUS Sleep Centre, SingHealth, Singapore, Singapore.

^# Contributed equally.

Abstract

Background: Emerging evidence has shown higher overall cancer incidence in patients with obstructive sleep apnea. Gastrointestinal cancers, including esophageal, stomach, liver, pancreas, and colorectal cancers account for 26% of incident cancers. However, the link between gastrointestinal cancers and obstructive sleep apnea is still unclear. We performed a systematic review and meta-analysis (registered PROSPERO CRD42021220836) to investigate the association between obstructive sleep apnea and incidence of gastrointestinal cancer.

Methods: We searched four electronic databases (PubMed, Embase, Cochrane Library, Scopus) and included studies published from inception till 15th November 2020 reporting the association of obstructive sleep apnea with gastrointestinal cancer incidence. Extracted data was meta-analyzed in a random-effects model.

Results: A total of seven studies were included, forming a combined cohort of 5,120,837 patients. Studies which adjusted for demographics and comorbidities were included in meta-analysis. Among four studies with 7-11 years of median follow-up, patients with obstructive sleep apnea experienced increased incidence of colorectal cancer (HR 1.70, 95% CI: 1.48-1.96, I²=22%). Pancreatic cancer incidence was nominally increased in three studies (HR 1.36, 95% CI: 0.88-2.09, I²=96), though this was not statistically significant. There was no association between obstructive sleep apnea and liver cancer incidence among three studies (HR 0.99, 95% CI: 0.81-1.22, I²=84). However, the lack of a statistically significant relationship between obstructive sleep apnea and pancreatic cancer in our meta-analysis does not necessarily imply the true absence of an association.

Conclusions: An increased risk of colorectal cancer was seen in patients with obstructive sleep apnea among studies with long-term follow-up. Further research is required to explore the utility of incorporating obstructive sleep apnea screening into colorectal cancer screening guidelines to identify high-risk individuals and to confirm a possible association of obstructive sleep apnea with pancreatic cancer.

Prospero registration: CRD42021220836.

Keywords: Obstructive sleep apnea; colorectal cancer; gastrointestinal cancer; meta-analysis; pancreatic cancer.