Sleep Apnea and Cancer, The Not-So-Silent Connection
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Dr. Hillary Lampers, ND

It’s February, St. Valentine’s month of love, chocolate, and cuddling with your partner in bed, until snoring like a freight train, drives many partners to the guest room, or couch. This scenario is played out in millions of bedrooms around the world due to the not-so-sexy condition of sleep apnea.

Sleep apnea has been creeping its way into our culture over the last half century, as the modern world becomes increasingly stressed, sedentary, overweight, and inflamed. Obstruction Sleep Apnea (OSD), the most common form of sleep apnea, occurs from blockage of the airway by soft tissue, secondary to tissue relaxation or neurological dysfunction during sleep. Affecting 18 million in the US alone, sleep apnea is as prevalent as diabetes1 and the most common sleep breathing disorder (SBD). Medical practitioners should be aware of the great number of patients who suffer with OSD, and patients should be screened for this disorder, especially if they are overweight, diabetic, smoker, male, and excessively fatigued. That being said, children, postmenopausal women, and skinny people can develop this condition as well.

The most common symptoms are:

  • loud snoring
  • difficulty staying asleep
  • cessations or pauses of breathing while asleep
  • waking with dry throat
  • morning headaches
  • excessive daily fatigue
  • frequent need for urination at night
  • memory or learning problems
  • poor concentration
  • depression

Sleep Apnea’s Link to Cancer

The overwhelming amount of literature that correlates OSD to cardiovascular disease, diabetes, and insulin resistance is also starting to indicate how oxygen deprivation may trigger increased cancer incidence and mortality.   Dr. Otto Warburg, a 1931 Nobel Prize Winner, who spent his career on cellular respiration and cancer stated in his studies, “Deprive a cell of 35% of it’s oxygen for 48 hours and it may become cancerous.”2 With oxygen deprivation, the body produces more blood vessels, the very thing that could lead to increased cancer tissues and tumor growth.3

The Wisconsin Sleep Cohort Study

Until an epidemiological study called the Wisconsin Sleep Cohort study was published in 2012, human evidence of SDB and cancer were lacking. 1,546 men and women in Wisconsin, ranging from age 30-60 were put through extensive medical testing, sleep studies, lifestyle analysis, and subjective complaints for upwards of 22 years. Out of this SBD group, 59% had severe OSA. Adjusting for age, sex, BMI, and smoking, those with SBD who were lacking oxygen under 90% saturation during sleep had a 4.8 greater risk of cancer mortality.4 Participants with increasing severity of SDB had significantly higher basal metabolic index (BMI), were more frequently male, little to no education, self-rated fair or poor health, and reported severe daytime sleepiness. Another interesting fact: many of those in this high risk group wore a CPAP machine during the study, the gold standard of treatment for OSA.

A similar study was done in Spain where over 4,900 people were examined and then followed for four years. Not one of the patients had a diagnosis of cancer when the study started, but those with OSD had a 68% higher chance of being diagnosed with cancer than those who did not have OSD in the end. Knowing that other lifestyle factors can affect cancer diagnosis, such as obesity or smoking, the research took into account these parameters and found that sleep apnea in all groups increased cancer risk and mortality.5 A 2014 published study also showed that OSA severity was associated with cancer mortality more frequently in people under age 65,6 while OSA is a potential risk factor for developing melanoma in men over age 65, probably due to increased years of intermittent hypoxia.7

While a recent meta-analysis published in the European Journal of Cancer Care finds that cancer incidence and mortality are not independently related to OSD8, the December 2015 Future Oncology states that recent studies reveal the potential for a strong relation.9 Poor sleep in general has shown increased risk for occurrence, especially oral, nasal, breast, and prostate cancers10. The Wisconsin Sleep Study researchers admit more needs to be done to examine the roles of treated vs. untreated SDB and survival rates of those who get cancer.

The CPAP alone isn’t enough

In the Wisconsin Sleep Cohort Study, many of those in the high risk group wore a CPAP machine during the study, but tended to be in poorer health overall. A controlled positive airway pressure (CPAP) device  is typically prescribed for OSA patients, but should not be looked at as enough to keep a person healthy. The CPAP can be uncomfortable and unattractive for many, and compliance is usually very low. New technology is emerging that allows patients to track their CPAP use, diet, and exercise weekly, thus increasing compliance secondary to monitoring change11 Simple phone coaching can also help to improve CPAP adherence.12 Addressing root causes of OSA, like cancer prevention, needs to start with lifestyle and environmental factors, with continuous communication and education by medical, supportive practitioners, and family members. OSA prevention, diagnosis and proper treatment will not only improve overall health and decrease future disease incidence, it could bring millions back to the bedroom, decreasing isolation and frustration for sufferers and their partners.

_DSC5667-EditDr. Hillary Lampers ND gained a BS in Natural Health Sciences with a Major in Nutrition and PreMed focus (2002) and a doctorate in Naturopathic Medicine (2007) both from Bastyr University.  She is founder and co-owner of Sky Valley Healing Arts in Snohomish, WA.

Dr. Hillary has integrated her training and knowledge to help patients with pain elimination, disease prevention, anti-aging, and lifestyle management. She is creator of the Get It Back online health coaching program, where she works 1:1 with patients, resetting hormone and brain chemistry to look and feel better. She has 15 years of advanced training in NeuroCranial Restructuring®, a revolutionary cranial and neurological therapy, and is currently one of only 18 globally certified practitioners.

When not learning from her patients, Dr. Hillary is spending time with her husband and two daughters in their garden, in the mountains, or traveling! Learn more about Dr. Hillary and her practice at drhillarylampers.com.

References:

  1. American Sleep Apnea Association, www.sleepapea.org/learn/sleep-apnea.html (viewed February 3, 2016)
  2. Otto Warburg Cell Physiologist, Biochemist and Eccentric” by Hans Krebs and Roswitha Schmid, Clarendon Press, Oxford, 1981
  3. Raghunand N, Gatenby RA, Gillies RJ. Microenvironmental and cellular consequences of altered blood flow in tumours. Br J Radiol 2003;76:S11–S22
  4. F. Javier Nieto, Paul E. Peppard, Terry Young, Laurel Finn, Khin Mae Hla, and Ramon Farré. Sleep-disordered Breathing and Cancer Mortality Results from the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med. 2012 Jul 15; 186(2): 190–194
  5. Campos-Rodriguez F, Martinez-Garcia MA, Martinez M, et al. Association between obstructive sleep apnea and cancer incidence in a large multicenter Spanish cohort. Am J Respir Crit Care Med. 2013;187:99–105.
  6. Martínez-García MA1, Campos-Rodriguez F2, Durán-Cantolla J3, de la Peña M4, Masdeu MJ5, González M6, Del Campo F7, Serra PC8, Valero-Sánchez I9, Ferrer MJ9, Marín JM10, Barbé F11, Martínez M12, Farré R13, Montserrat JM14; Spanish Sleep Network. Obstructive sleep apnea is associated with cancer mortality in younger patients. Sleep Med. 2014 Jul;15(7):742-8.
  7. Martínez-García M-Á, Martorell-Calatayud A, Nagore E, et al. Association between sleep disordered breathing and aggressiveness markers of malignant cutaneous melanoma. Eur Respir J 2014; 43: 1661–1668.
  8. Zhang XB, Peng LH, Lyu Z, Jiang XT, Du YP. Obstructive sleep apnoea and the incidence and mortality of cancer: a meta-analysis. Eur J Cancer Care (Engl). 2015 Dec 10.
  9. Kukwa W, Migacz E, Druc K, Grzesiuk E, Czarnecka AM. Obstructive sleep apnea and cancer: effects of intermittent hypoxia? Future Oncol. 2015 Dec;11(24):3285-98.
  10. Fang HF, Miao NF, Chen CD, Sithole T, Chung MH. Risk of Cancer in Patients with Insomnia, Parasomnia, and Obstructive Sleep Apnea: A Nationwide Nested Case-Control Study. J Cancer. 2015 Sep 15;6(11):1140-7.
  11. Isetta V, Torres M, González K, Ruiz C, Dalmases M, Embid C, Navajas D, Farré R, Montserrat JM. A New mHealth application to support treatment of sleep apnoea patients. J Telemed Telecare. 2015 Dec 15.
  12. Sedkaoui K, Leseux L, Pontier S, Rossin N, Leophonte P, Fraysse JL, Didier A.Efficiency of a phone coaching program on adherence to continuous positive airway pressure in sleep apnea hypopnea syndrome: a randomized trial. BMC Pulm Med. 2015 Sep 14;15:102
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