Untreated obstructive sleep apnea raises risk for poor prognosis in melanoma

Key takeaways:

• The risk for death, melanoma recurrence or metastasis was high among patients with this cancer and untreated obstructive sleep apnea vs. no sleep apnea.
• Adherence to CPAP was found to normalize this risk.

Among patients with melanoma, untreated moderate to severe obstructive sleep apnea increased the risk for poor long-term prognosis of skin cancer, according to results published in CHEST.

“The presence of OSA emerges as a new risk factor for a poor long-term prognosis of cutaneous melanoma,” Jose Daniel Gómez-Olivas, MD, of the respiratory department at the Hospital Universitario y Politecnico La Fe, and colleagues wrote. “However, if underlying OSA is treated with CPAP and patients adhere to CPAP, the risk imposed by OSA on cutaneous melanoma outcomes is normalized.”

In a prospective longitudinal multicenter study, Gómez-Olivas and colleagues analyzed 443 patients (mean age, 65.1 years; 49% men; Breslow index, 1.7 mm) with cutaneous melanoma and sleep study data within 6 months of diagnosis to find out the impact of OSA and CPAP treatment on disease prognosis (composite of melanoma recurrence, metastasis or all-cause mortality) at a 5-year follow-up.

Five-year data were available for 391 out of 443 patients, with a median follow-up period of 60 months.

Within this cohort, 139 patients did not have OSA (apnea-hypopnea index [AHI] < 10 events/hour). Researchers grouped the remaining patients according to AHI and CPAP usage: 78 patients had moderate/severe OSA and good adherence to CPAP, 124 patients had moderate OSA (AHI, 10-29 events/hour) and poor adherence/no CPAP usage and 50 patients had severe OSA (AHI, ≥ 30 events/hour) and poor adherence/no CPAP usage.

The average length of CPAP use was 4.7 hours among the patients with good adherence, according to researchers.

A similar number of metastases and all-cause deaths took place in the follow-up period (53 and 52, respectively), and melanoma metastasis was the reason behind 48 deaths. Additionally, melanoma recurrence was seen 32 times in the total cohort.

Patients in the untreated moderate OSA cohort experienced the most events (43 events), whereas patients in the treated OSA cohort had the lowest number of events (15 events).

Researchers assessed each group’s risk for poor melanoma prognosis against the group without OSA in Cox multivariate analysis that accounted for age, sex, BMI, Breslow index, Epworth sleepiness scale scores, melanoma treatment, sentinel lymph nodes affected at diagnosis, diabetes and nighttime with an oxygen saturation less than 90%.

The highest risk for poor prognosis when compared with patients without OSA was found among patients with untreated severe OSA (adjusted HR = 2.96; 95% CI, 1.36-6.42), followed by patients with untreated moderate OSA (aHR = 2.45; 95% CI, 1.09-5.49).

With an adjusted hazard ratio of 1.66 (95% CI, 0.71-3.9), the researchers said that there was no evidence for increased risk among patients with OSA and CPAP adherence compared with patients who did not have OSA, which suggests that this sleep apnea treatment may improve outcomes related to melanoma.

“Future larger studies clearly are necessary to corroborate our results and to analyze more specific prognostic outcomes while incorporating more precise clinical phenotypes,” Gómez-Olivas and colleagues wrote.