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  3. Role of Sleep Apnea and Long-Term CPAP Treatment in the Prognosis of Patients With Melanoma: A Prospective Multicenter Study of 443 Patients

Role of Sleep Apnea and Long-Term CPAP Treatment in the Prognosis of Patients With Melanoma: A Prospective Multicenter Study of 443 Patients

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Campos-Rodriguez F.
  • Nagore E.
  • Martorell A.
  • García-Rio F.
  • Cubillos C.
  • Hernandez L.
  • Bañuls J.
  • Arias E.
  • Ortiz P.
  • Cabriada V.
  • Gardeazabal J.
  • Montserrat J.M.
  • Carrera C.
  • Masa J.F.
  • Gomez de Terreros J.
  • Abad J.
  • Boada A.
  • Mediano O.
  • Castillo-Garcia M.
  • Chiner E.
  • Landete P.
  • Mayos M.
  • Fortuna A.
  • Barbé F.
  • Sanchez-de-la-Torre M.
  • Cano-Pumarega I.
  • Perez-Gil A.
  • Gomez-Garcia T.
  • Cullen D.
  • Somoza M.
  • Formigon M.
  • Aizpuru F.
  • Garcia-Ortega A.
  • Almendros I.
  • Farré R.
  • Gozal D.

Grupos

Abstract

Background: 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 associated independently with a poor prognosis for cutaneous melanoma? Study Design and Methods: Four hundred forty-three patients with a diagnosis of cutaneous melanoma (2012-2015) underwent a sleep study within 6 months of diagnosis. The main 5-year outcome of the study was a composite of melanoma recurrence, metastasis, or mortality. Patients were divided into four groups: baseline apnea-hypopnea index (AHI) of fewer than 10 events/h (no OSA; control group), OSA treated with CPAP and good adherence, untreated or poor CPAP adherence in 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: Three hundred ninety-one patients (88.2%) were available for analysis at 5-year follow-up (mean age, 65.1 ± 15.2 years; 49% male; Breslow index, 1.7 ± 2.5 mm). One hundred thirty-nine patients had AHI of fewer than 10 events/h (control group); 78 patients with OSA were adherent to CPAP; and 124 and 50 patients had moderate and severe OSA, respectively, without CPAP treatment. Median follow-up was 60 months (interquartile range, 51-74 months). During follow-up, 32 relapses, 53 metastases, and 52 deaths occurred (116 patients showed at least one of the main composite outcomes). After adjusting for age, sex, sentinel lymph nodes affected at diagnosis, BMI, diabetes, nighttime with an oxygen saturation below 90%, Breslow index, Epworth sleepiness scale scores, and melanoma treatment, moderate (hazard ratio [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 compared with untreated moderate to severe OSA. © 2023 American College of Chest Physicians

Datos de la publicación

ISSN/ISSNe:
0012-3692, 1931-3543

CHEST  ELSEVIER

Tipo:
Article
Páginas:
1551-1559
PubMed:
37348828
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
2,264 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 16

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Keywords

  • Aged; Aged, 80 and over; Continuous Positive Airway Pressure; Female; Humans; Male; Melanoma; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Prospective Studies; Skin Neoplasms; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; adult; age; aged; aggressiveness; apnea hypopnea index; Article; body mass; cancer prognosis; cancer recurrence; clinical outcome; continuous positive airway pressure; controlled study; cross-sectional study; cutaneous melanoma; diabetes mellitus; disease severity; Epworth sleepiness scale; female; follow up; human; longitudinal study; major clinical study; male; middle aged; mortality rate; obstructive sleep apnea; oxygen saturation; patient compliance; risk factor; sentinel lymph node metastasis; sex; sleep study; survival analysis; clinical trial; complication; continuous positive airway pressure; epidemiology; melanoma; multicenter study; prognosis; prospective study; skin tumor; sleep apnea syndromes; tumor recurrence; very elderly

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