Association of sleep-related hypoxia with survival in patients with non-small cell lung cancer – the NEOSAS-GFPC study group

Sleep-disordered breathing (SDB) and nocturnal hypoxia have been shown to be associated with all-cancer and lung cancer incidence. The prevalence and clinical relevance of SDB in patients with lung cancer remain to be investigated. We conducted a prospective, multi-center study within the GFPC network to assess the prevalence of SDB among patients with NSCLC, and the association with quality of life (QOL) and overall survival (OS). Patients underwent home sleep apnea testing (HSAT, ApneaLink, ResMed) and fulfilled sleep and QOL questionnaires, then were followed for 18 months. The diagnosis of SDB was defined as an 3% oxygen desaturation index (3%ODI) of at least 15 events/h. Between February 2016 and December 2020, 1201 patients with newly diagnosed NSCLC were included. Of 1201 patients, 1001 with valid HSAT were analyzed, 383 of whom (38%) had SDB. Patients with SDB were more frequently male (p<0.0001), had older age (p<0.0001) and higher body mass index (p<0.0001) than those without SDB. There was no association of SDB with QOL excepted for excessive daytime sleepiness (median[IQR] Epworth score: 5.2[3.7] vs 4.7[3.7]; p=0.04), nor with OS. However, patients with marked nocturnal hypoxia (≥36% of sleep recording time with SpO2 <90%, T90)) were at higher risk of death (hazard ratio [95% confidence interval]: 1.37[1.07-1.77]; p=0.01) compared to those with T90<4%) after adjustment for age, gender, BMI, alcohol and tobacco consumption, history of COPD, and NSCLC stage at diagnosis. SDB is highly prevalent in patients with newly diagnosed NSCLC. Sustained nocturnal hypoxia estimated through T90 is independently associated with lower OS.