ROLE OF SLEEP APNEA AND LONG-TERM CPAP TREATMENT IN THE PROGNOSIS OF PATIENTS WITH MELANOMA.

Autores de IIS La Fe

• Nagore Fernandez-Llanio Comella

  Autor

• Maria Teresa Garcia Vozmediano

  Autor

• Irene Cano Pumarega

  Autor

• Grace Jacqueline Oscullo Yépez

  Autor

• Alberto García Ortega

  Autor

• Vicente Renovell Farre

  Autor

• 

  Miguel Ángel Martínez García

  Autor

Participantes ajenos a IIS La Fe

• Gomez-Olivas, Jose Daniel
• Campos-Rodriguez, Francisco
• Martorell, Antonio
• Garcia-Rio, Francisco
• Cubillos, Carolina
• Hernandez, Luis
• Banuls, Jose
• Arias, Eva
• Ortiz, Pablo
• Cabriada, Valentin
• Gardeazabal, Juan
• Montserrat, Josep Maria
• Carreres, C
• Masa, Juan Fernando
• Gomez de Terreros, J
• Abad, Jorge
• Boada, Adam
• Castillo-Garcia, Marta
• Chiner, Eusebi
• Landete, Pedro
• Mayos, Mercedes
• Fortuno, A
• Barbe, Ferran
• Sanchez-de-la-Torre, Manuel
• Perez-Gil, Amalia
• Gomez-Garcia, Teresa
• Cullen, Daniela
• Somoza, Maria
• Formigon, Manuel
• Aizpuru, Felipe
• Almendros, Isaac
• Gozal, David

Grupos

• Neumología

  

  Leader

  Miguel Ángel Martínez García

Abstract

BACKGROUND: Obstructive sleep apnea (OSA) has been associated with increased incidence and aggressiveness of melanoma. However, the long-term impact of OSA and CPAP treatment on the prognosis of melanoma remains unexplored. RESEARCH QUESTION: Are OSA and CPAP treatment independently associated with a poor prognosis for cutaneous melanoma? STUDY DESIGN AND METHODS: 443 diagnosed cutaneous melanoma patients (2012-2015) underwent a sleep study within 6 months of diagnosis. Main study 5-year outcome was a composite of melanoma recurrence, metastasis or mortality. Patients were divided into 4 groups: baseline AHI<10 events/h (no OSA, control group), OSA treated with CPAP and good adherence, untreated or poor CPAP adherence moderate (AHI:10-29 events/h) and severe OSA (AHI=30 events/h). Survival analysis was used to determine the independent role of OSA and CPAP treatment on melanoma composite outcome. RESULTS: 391 patients (88.2%) were available for analysis at 5-year follow-up (mean age: 65.1±15.2 years; 49% males; Breslow index: 1.7±2.5 mm). 139 patients had AHI<10 (controls); 78 OSA patients were adherent to CPAP; 124 and 50 with moderate and severe OSA without CPAP respectively. Median follow-up was 60 (51-74) months. During follow up there were 32 relapses, 53 metastasis and 52 deaths (116 patients had at least one of the main composite outcome). After adjusting for age, gender, sentinel lymph nodes affected at diagnosis, body mass index, diabetes mellitus, Tsat90%, Breslow index, Epworth Sleepiness Scale, and melanoma treatment, moderate (HR, 2.45; 95%CI:1.09-5.49) and severe OSA (HR, 2.96; 95%CI:1.36-6.42) were associated with poorer prognosis of melanoma compared with the control group. However, good adherence to CPAP avoided this excess risk (HR, 1.66; 95%CI:0.71-3.90). INTERPRETATION: Moderate-to-severe untreated OSA is an independent risk factor for poor prognosis of melanoma. Treatment with CPAP is associated with improved melanoma outcomes than untreated moderate-to-severe OSA.

Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Keywords

• Melanoma; aggressiveness; cancer; continuous positive airway pressure; mortality; sleep apnea