Is obstructive sleep apnea a driver of cancer and chronic disease risk? A real-world analysis of over 3 million patients

BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder linked to substantial cardiovascular, pulmonary and metabolic morbidity. Recent observations have raised the question that OSA may also contribute to cancer development. This study aimed to evaluate the association between OSA and the 5-year incidence of cancer, cardiometabolic, pulmonary and metabolic disorders in a large real-world hospitalized population. METHODS: A retrospective analysis of the TriNetX research database was conducted. Two cohorts of 1,524,190 adults with and without OSA, matched for age and sex, were analyzed for incident cancer, chronic ischemic heart disease, chronic obstructive pulmonary disease (COPD), asthma, overweight/obesity, and diabetes mellitus. Risk estimates, risk differences, risk ratios (RR), and odds ratios were calculated; cancer risk was additionally analyzed using Kaplan-Meier curves and log-rank tests. Significance was indicated by p < 0.05. RESULTS: OSA was associated with significantly higher 5-year incidences of all predefined outcomes, including cancer (RR 1.40), chronic ischemic heart disease (RR 1.36), COPD (RR 1.64), asthma (RR 1.96), diabetes mellitus (RR 1.51), and overweight/obesity (RR 2.70) (p < 0.001). CONCLUSIONS: In this large real-world analysis, OSA was associated with increased 5-year risks of incident cancer and major cardiovascular, pulmonary, and metabolic diseases. The magnitude of cancer risk was comparable to that of non-malignant chronic conditions, supporting the concept of OSA as a systemic disorder characterized by multisystem morbidity.