Untreated Obstructive Sleep Apnea Related to Poor Melanoma Outcomes

Untreated moderate or severe obstructive sleep apnea (OSA) independently increased the risk for poor outcomes in patients diagnosed with cutaneous melanoma, according to study findings published in the journal Chest.

Previous research has made the connection between OSA and increased incidence and aggressiveness of melanoma, but the effects of OSA treatment and OSA severity on melanoma risk are unknown.

Researchers in Spain conducted a prospective, longitudinal, multicenter study of 443 individuals (mean age of 65.1 years; 49% male) diagnosed with cutaneous melanoma between October 2012 and September 2015 who underwent a sleep study within 6 months of diagnosis. They sought to determine if OSA severity increased risk for poor melanoma outcomes and if adequate OSA treatment remediated potential risk.

Of the 443 individuals, 391 (88.2%) completed 60 months of follow-up. The researchers analyzed a composite outcome consisting of all-cause mortality, melanoma recurrence, or metastasis after 5 years, following initial diagnosis of cutaneous melanoma.

Based on sleep study results, the researchers divided the 391 participants into 4 groups:

• 139 people in a control group that did not have OSA (apnea-hypopnea index [AHI]: <10 events/hour)
• 78 individuals with moderate (AHI: 10-29 events/hour) or severe (AHI: ³30 events) OSA with good adherence to continuous positive airway pressure (CPAP) treatment
• 124 individuals with moderate OSA that was either untreated or with poor adherence to CPAP
• 50 individuals with severe OSA that was either untreated or with poor adherence to CPAP

After 5 years, 116 of the 391 participants experienced at least 1 of the 3 main composite outcomes, totaling 32 melanoma relapses, 53 metastases, and 52 all-cause deaths — 48 of which were directly related to melanoma metastasis.

The researchers discovered that compared with the control group, both moderate (hazard ratio [HR]: 2.45, 95% CI, 1.09-5.49; P =.029) and severe (HR: 2.96; 95% CI, 1.36-6.42; P =.006) OSA correlated with poorer melanoma outcomes. They noted that individuals with good adherence to CPAP treatment mitigated risk for poor outcomes (HR: 1.66; 95% CI, 0.71-3.90; P =.241).

“Moderate-to-severe untreated OSA is an independent risk factor for poor prognosis of melanoma,” the researchers concluded. “Treatment with CPAP is associated with improved melanoma outcomes than untreated moderate-to-severe OSA,” they added.

Study limitations included substantial treatment heterogeneity (pharmacological, radiation, or surgical) for melanoma, inability to exclude the possibility that changes in severity of OSA may have occurred over time, and use of a composite outcome measure consisting of tumor recurrence, all-cause mortality, and cancer metastasis, which weakened statistical power as opposed to individual assessment of these outcomes.