Benjamin Kye Jyn Tan1, Nicole Kye Wen Tan1, Yao Hao Teo1, Dominic Wei Ting Yap1, Jaivikash Raghupathy1, Esther Yanxin Gao1, Song Tar Toh2,3, Anna See4,5. 1. Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore. 2. Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Outram Road, Singapore, 169608, Singapore. 3. Surgery Academic Clinical Program, SingHealth, Singapore, Singapore. 4. Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Outram Road, Singapore, 169608, Singapore. anna.see.xinyin@singhealth.com.sg. 5. Surgery Academic Clinical Program, SingHealth, Singapore, Singapore. anna.see.xinyin@singhealth.com.sg.
Abstract
PURPOSE: Obstructive sleep apnea (OSA) is a postulated carcinogen based on epidemiological associations with all-cancer incidence and non-thyroid biological models. However, associations with thyroid carcinoma are unclear. METHODS: We included observational/randomized studies of associations of OSA with thyroid carcinoma incidence/mortality in adults, from four databases. Random-effects meta-analyses and the population attributable fraction (PAF; from published global OSA prevalence estimates) were computed. RESULTS: We included four observational studies (N = 2,839,325), all with moderate/low risk of bias. OSA diagnosis was associated with twofold incidence of thyroid carcinoma (pooled HR 2.32, 95% CI 1.35-3.98, I2 = 95%), after multi-adjustment for demographics, BMI, smoking, alcohol, and comorbidities. Subgroup analysis of studies with at least 5 years of follow-up showed a stronger association of OSA with thyroid cancer incidence (pooled HR 3.27, 95% CI 2.80-3.82, I2 = 0%). Up to 14.5% (95% CI 4.29-27.6%) of incident thyroid carcinomas globally may be associated with OSA. Thyroid carcinoma mortality data was unavailable. CONCLUSIONS: OSA is associated with higher thyroid carcinoma incidence, though this does not prove causation. Biological/clinical studies should investigate OSA severity in relation to thyroid carcinoma progression and mortality, stratified by tumor histology.
PURPOSE: Obstructive sleep apnea (OSA) is a postulated carcinogen based on epidemiological associations with all-cancer incidence and non-thyroid biological models. However, associations with thyroid carcinoma are unclear. METHODS: We included observational/randomized studies of associations of OSA with thyroid carcinoma incidence/mortality in adults, from four databases. Random-effects meta-analyses and the population attributable fraction (PAF; from published global OSA prevalence estimates) were computed. RESULTS: We included four observational studies (N = 2,839,325), all with moderate/low risk of bias. OSA diagnosis was associated with twofold incidence of thyroid carcinoma (pooled HR 2.32, 95% CI 1.35-3.98, I2 = 95%), after multi-adjustment for demographics, BMI, smoking, alcohol, and comorbidities. Subgroup analysis of studies with at least 5 years of follow-up showed a stronger association of OSA with thyroid cancer incidence (pooled HR 3.27, 95% CI 2.80-3.82, I2 = 0%). Up to 14.5% (95% CI 4.29-27.6%) of incident thyroid carcinomas globally may be associated with OSA. Thyroid carcinoma mortality data was unavailable. CONCLUSIONS: OSA is associated with higher thyroid carcinoma incidence, though this does not prove causation. Biological/clinical studies should investigate OSA severity in relation to thyroid carcinoma progression and mortality, stratified by tumor histology.
Authors: Nigel McArdle; Sarah V Ward; Romola S Bucks; Kathleen Maddison; Anne Smith; Rae-Chi Huang; Craig E Pennell; David R Hillman; Peter R Eastwood Journal: Sleep Date: 2020-10-13 Impact factor: 5.849