Risk for lung cancer reoccurrence may be associated with OSA-related hypoxemia

Key takeaways:

• In univariate analysis, a 4% oxygen desaturation index greater than 15 was significantly linked to lung cancer reoccurrence.
• Two hypoxic burden measures continued to be significant in adjusted analysis.

Potential risk factors for lung cancer reoccurrence within 2 years include obstructive sleep apnea-related episodic hypoxemia and hypoxic burden, according to research presented at SLEEP 2024.

“We were suspecting that we would find a positive association between measures of intermittent hypoxemia and lung cancer reoccurrence; nonetheless, we never expected to see such a strong signal,” Fernando Figueroa Rodriguez, MD, sleep medicine fellow at the Mayo Clinic in the division of pulmonary, critical care and sleep medicine in Rochester, Minnesota, said in a press release.

In a retrospective record review, Figueroa Rodriguez and colleagues evaluated 403 adults (median age, 74 years; 52% women) with history of non-small cell lung cancer (NSCLC) and overnight oximetry study data 3 years before receiving curative malignancy treatment to determine the link between OSA-related episodic hypoxemia and lung cancer reoccurrence in less than 2 years.

Within the cohort, 68% had a histological subtype of adenocarcinoma, whereas 22% had a subtype of squamous cell carcinoma.

Researchers identified patients’ NSCLC stage using the tumor, node and metastasis (TNM) system and found 35% with stage IA1, 24.1% with stage IA2 and 19% with stage IB cancer.

Most of the study population did not experience lung cancer again, but 22% (n = 68) did experience reoccurrence.

Regardless of included demographics, histologic subtype and cancer stage, univariate analysis revealed significant relationships (P < .001) between lung cancer reoccurrence in less than 2 years and OSA-related episodic hypoxemia, as well as hypoxic burden measures:

• 4% oxygen desaturation index (ODI) greater than 15;
• time spent in desaturation;
• time spent below 89% SpO₂;
• average SpO₂ below 89%; and
• single nadir oxygen levels.

Researchers noted that only two of the above factors were still “strongly correlated” with lung cancer recurrence in less than 2 years when using a multivariate proportional hazard survival model: average SpO₂ below 89% and single nadir oxygen level.

“The multivariate model demonstrated correlation with hypoxic load measures only, suggesting the need for a larger sample to elucidate the involvement of this highly treatable risk factor,” Figueroa Rodriguez and colleagues wrote.

Reference:

• Hypoxemia due to sleep apnea is associated with risk of lung cancer reoccurrence. https://www.sleepmeeting.org/hypoxemia-due-to-sleep-apnea-is-associated-with-risk-of-lung-cancer-reoccurrence/. Published June 4, 2024. Accessed June 5, 2024.