Human Papillomavirus and Thyroid Cancer: Transformative Insights Into Postoperative Interventions and Sleep Quality Improvement: A Comprehensive Meta-Analysis

Context: Human papillomavirus (HPV) is a well-established oncogenic virus implicated in cervical, oropharyngeal, and anogenital malignancies. Emerging evidence suggests its potential role in thyroid cancer pathogenesis. Patients with thyroid cancer frequently experience obstructive sleep apnea (OSA), which may be exacerbated by thyroid dysfunction. Thyroidectomy has been reported to improve sleep quality; however, the interplay between HPV infection, thyroid cancer progression, and postoperative sleep improvements remains inadequately understood. This meta-analysis systematically evaluates the impact of thyroidectomy on sleep parameters in thyroid cancer patients, with a specific focus on those affected by HPV. Objectives: To quantify the effects of thyroidectomy on sleep quality in patients with thyroid cancer, particularly those with HPV infection. This study assesses improvements in key OSA indicators, including the Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), and nocturnal oxygen saturation, while elucidating the clinical implications of the HPV-thyroid cancer association. Methods: A comprehensive literature search was conducted across PubMed, Embase, Scopus, and the Cochrane Library for studies published between January 2010 and December 2024. Eligible studies included randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating postoperative sleep outcomes in thyroid cancer patients with documented HPV status. Two independent reviewers conducted data extraction and quality assessment, resolving discrepancies through consensus. The methodological rigor of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS) and the Cochrane risk of bias tool. A meta-analysis was performed using the DerSimonian and Laird random-effects model, with heterogeneity assessed via Cochran’s Q and I2 statistics. Publication bias was examined using funnel plots and Egger’s test. Results: Out of 203 screened records, 11 studies (comprising 1,432 participants) met the inclusion criteria. Thyroidectomy led to statistically and clinically significant improvements in sleep quality. The mean preoperative AHI of 42.8 ± 8.6 declined to 36.6 ± 8.4 postoperatively (Hedges’ g = -0.38, 95% CI: -0.67 to -0.09, P = 0.01), reflecting a moderate yet meaningful improvement in OSA severity. Daytime sleepiness showed a substantial reduction, with ESS scores decreasing from 15.3 ± 4.7 to 7.5 ± 6.07, demonstrating a marked enhancement in daily functioning. The HPV infection was associated with a 2.2-fold increased risk of thyroid cancer (OR = 2.199, 95% CI: 1.31 - 3.23, P < 0.05), reinforcing its potential role in thyroid carcinogenesis. Moderate heterogeneity was observed in OSA-related outcomes (I2 = 59.27%, P = 0.01), while the HPV-thyroid cancer association displayed minimal heterogeneity (I2 = 0.00%, P = 0.64). Conclusions: Thyroidectomy significantly enhances sleep quality in thyroid cancer patients, with notable reductions in AHI and ESS scores, underscoring its clinical benefit. The strong association between HPV and thyroid cancer highlights the potential necessity of HPV screening in thyroid cancer risk assessment and postoperative surveillance. These findings advocate for the consideration of HPV as a modifiable risk factor, warranting further research into tailored screening protocols and refined postoperative strategies to optimize patient outcomes.