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Role of Sleep Apnea and Long-Term CPAP Treatment in the Prognosis of Patients With Melanoma

2023; Elsevier BV; Volume: 164; Issue: 6 Linguagem: Inglês

10.1016/j.chest.2023.06.012

1931-3543

José Daniel Gómez-Olivas, Francisco Campos‐Rodríguez, Eduardo Nagore, A. Martorell, Francisco García‐Río, Carolina Cubillos‐Zapata, Luís Hernández, José Bañuls, Eva Arias, Pablo L. Ortiz‐Romero, Valentín Cabriada, Juan Gardeazabal, Josep M. Montserrat, Cristina Carrera, Juan F. Masa, Javier Gómez de Terreros, Jorge Abad, Aram Boada, Olga Mediano, Marta Castillo-Garcia, Eusebi Chiner, Pedro Landete, Mercedes Mayos, Ana María Fortuna, Ferrán Barbé, Manuel Sánchez‐de‐la‐Torre, Irene Cano‐Pumarega, Amalia Pérez‐Gil, Teresa Gómez‐García, D. Cullen, María Salgado Somoza, Manuel Formigón, Felipe Aizpuru, Grace Oscullo, Alberto García‐Ortega, Isaac Almendros, Ramón Farré, David Gozal, Miguel Ángel Martínez‐García,

Lymphatic System and Diseases

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 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 mellitus, Tsat90%, Breslow index, Epworth sleepiness scale, 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 than untreated moderate to severe OSA. 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. Are OSA and CPAP treatment associated independently with a poor prognosis for cutaneous melanoma? 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 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. 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 mellitus, Tsat90%, Breslow index, Epworth sleepiness scale, 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). 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.