Obstructive Sleep Apnea and the Risk of Cardiovascular Disease and Stroke Among Patients With Cancer: Analyses From a Multicenter Electronic Health Care Records‐Based Database

BACKGROUND: Obstructive sleep apnea (OSA) and cancer are independently associated with increased cardiovascular disease (CVD) risk. However, it is unclear whether OSA confers additional CVD risk among individuals with cancer. METHODS: A retrospective cohort study was conducted using the TriNetX database, including adults ≥40 years diagnosed with cancer between 2012 and 2023. Individuals with and without OSA were propensity score matched on demographics and comorbidities. The primary outcome was a composite of heart failure, atrial fibrillation/flutter, myocardial infarction, coronary revascularization, ischemic stroke, and all-cause mortality. Cox proportional hazards models were used for time-to-event analyses, with subgroup analyses by sex and body mass index. RESULTS: Among 4 801 487 patients with cancer, 643 143 had OSA. After matching (N = 629 114 per group), those with OSA had a higher risk of the composite CVD outcome (n events=189 090; hazard ratio [HR], 1.27 [95% CI, 1.26-1.28]). OSA was associated with increased risks of heart failure (HR, 1.80 [95% CI, 1.78-1.83]), atrial fibrillation/flutter (HR, 1.71 [95% CI, 1.69-1.74]), myocardial infarction (HR 1.42 [95% CI, 1.39-1.45]), and ischemic stroke (HR, 1.41 [95% CI, 1.38-1.44]). Paradoxically, all-cause mortality was lower in the group with OSA (HR, 0.84 [95% CI, 0.83-0.85]). The highest heart failure risk was seen in women with OSA. CVD risk persisted across body mass index groups, including individuals without obesity. CONCLUSIONS: OSA significantly increases the risk of CVD events in patients with cancer, especially heart failure in women, regardless of obesity status. These findings support routine OSA screening and potential early intervention in oncology populations to mitigate CVD risk.