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Clinical Research

Obesity, sleep apnea, and cancer

International Journal of Obesity volume 44, pages 1653–1667 (2020)Cite this article

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Abstract

The interest on a potential association between cancer and sleep-disordered breathing (SDB) has clearly gained substantial traction over the last several years. This novel relationship was initially explored in experimental models of obstructive sleep apnea (OSA) and showed that both intermittent hypoxia and sleep fragmentation, the two main hallmarks of OSA, promoted alterations in both tumorigenesis and tumor malignant properties. In parallel, an intriguing role of obesity as a major interactive player in the relationship between cancer and OSA was postulated in the following contextual settings: (1) obesity (with or without OSA) is associated with increased risk of some types of cancer (both incidence and aggressiveness), whereas obesity could be protective for others (“obesity paradox”); (2) OSA has been associated with increased risk for some types of cancer (independent of obesity), but not with others; (3) More than 80% of adult patients with OSA are overweight and >50% are obese; (4) both OSA and obesity exhibit oscillations in tissue oxygen tensions in peripheral organs such as adipose tissues. Further understanding these complex relationships become all the more important considering that the prevalence of obesity, cancer and OSA are all increasing worldwide. In parallel, experimental models of OSA provide biological plausibility constructs to the clinical and epidemiological findings, suggesting that the metabolic and inflammatory changes induced by chronic intermittent hypoxia and sleep fragmentation may foster or exacerbate immune and biomechanical alterations of the tumor microenvironment, including the expression of extracellular matrix components facilitating tumor progression.

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Fig. 1: Cancer incidence in patients with OSA according to various criteria of severity and after adjustment by body mass index or obesity.
Fig. 2: Cancer mortality or aggressiveness in patients with OSA according to various criteria of severity and after adjustment by body mass index or obesity.
Fig. 3: Effects of sleep apnea on adipose tissue and on tumor.
Fig. 4: Simplified diagram illustrating the force transmission mechanism in the crosstalk between the ECM and cells.

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Funding

This work was supported in part by the Spanish Ministry of Economy and Competitiveness (SAF2017-85574-R) and Generalitat de Catalunya (Programa CERCA). IA is supported by SEPAR (595/2017) and DG by National Institutes of Health grants HL130984 and HL140548.

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Authors and Affiliations

  1. Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain

    Isaac Almendros & Ramon Farré

  2. Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain

    Isaac Almendros & Ramon Farré

  3. Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain

    Isaac Almendros & Ramon Farré

  4. Respiratory Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain

    Miguel A. Martinez-Garcia

  5. Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, 65201, USA

    David Gozal

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  1. Isaac Almendros
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  2. Miguel A. Martinez-Garcia
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  3. Ramon Farré
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  4. David Gozal
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Correspondence to David Gozal.

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Almendros, I., Martinez-Garcia, M.A., Farré, R. et al. Obesity, sleep apnea, and cancer. Int J Obes 44, 1653–1667 (2020). https://doi.org/10.1038/s41366-020-0549-z

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  • DOI: https://doi.org/10.1038/s41366-020-0549-z

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