Sleep-Disordered Breathing Is Independently Associated With Increased Aggressiveness of Cutaneous Melanoma: A Multicenter Observational Study in 443 Patients

doi:10.1016/j.chest.2018.07.015

. 2018 Dec;154(6):1348-1358.

doi: 10.1016/j.chest.2018.07.015. Epub 2018 Jul 27.

Sleep-Disordered Breathing Is Independently Associated With Increased Aggressiveness of Cutaneous Melanoma: A Multicenter Observational Study in 443 Patients

Miguel Angel Martinez-Garcia¹, Francisco Campos-Rodriguez², Eduardo Nagore³, Antonio Martorell⁴, Jose Luis Rodriguez-Peralto⁵, Erica Riveiro-Falkenbach⁵, Luis Hernandez⁶, Jose Bañuls⁷, Eva Arias⁸, Pablo Ortiz⁹, Valentin Cabriada¹⁰, Jose Gardeazabal¹¹, Josep Maria Montserrat¹², Cristina Carrera¹³, Jaime Corral¹⁴, Juan Fernando Masa¹⁴, Javier Gomez de Terreros¹⁴, Jorge Abad¹⁵, Adam Boada¹⁶, Olga Mediano¹⁷, Esther de Eusebio¹⁸, Eusebi Chiner¹⁹, Pedro Landete¹⁹, Mercedes Mayos²⁰, Ana Fortuño²⁰, Ferrán Barbé²¹, Manuel Sánchez de la Torre²¹, Alicia Sanchez de la Torre²¹, Irene Cano²², Cristina Gonzalez²³, Amalia Pérez-Gil²⁴, Teresa Gómez-García²⁵, Daniela Cullen²⁶, Maria Somoza²⁷, Manuel Formigón²⁸, Felipe Aizpuru²⁹, Cristina Navarro³⁰, Maria Jose Selma-Ferrer³⁰, Alberto Garcia-Ortega³⁰, Blanca de Unamuno³¹, Isaac Almendros³², Ramón Farré³², David Gozal³³; Spanish Sleep Network

Collaborators, Affiliations

Collaborators

Spanish Sleep Network:
Isabel Betlloch, Manuel Moragon, Esther Pastor, Verónica Velasco, Amaia Urrutia, Cristian Perna, Zully Vásquez, Jose Antonio Aramburu, Aida Muñoz, M Angeles Gonzalez, Joan Dalmau, Rosa M Marti, Ana Mozos, Erika Miranda, Maider Mateos, Paula Rodriguez, M Fernanda Troncoso, Monica de la Peña, Luis Javier Del Pozo, Mónica Gonzalez, Pilar Manchado, Santiago Antonio Juarros, Julian Caballero, Eduardo Alcaraz, Andrea Crespo, Jesús Martín, Lorena Comeche, Martina Alés, Monica Llombart, María Pérez-Crespo, Bienvenido Barreiro, Neus Curco, Olga Cantalejo, Nuria Reyes-Nuñez, Antonio Cruz-Medina, Raquel Catalá, Antonio Azón, Nuria Grau, Sonia Segura

Affiliations

¹ Respiratory Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain. Electronic address: mianmartinezgarcia@gmail.com.
² Respiratory Department, Hospital Valme, Seville, Spain.
³ Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain.
⁴ Dermatology Department, Hospital de Manises, Valencia, Spain.
⁵ Anatomic Pathology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
⁶ Respiratory Department, Hospital General Universitario de Alicante, Alicante, Spain.
⁷ Dermatology Department, Hospital General Universitario de Alicante, Alicante, Spain.
⁸ Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
⁹ Dermatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
¹⁰ Respiratory Department, Hospital Universitario Cruces de Bilbao, Bilbao, Spain.
¹¹ Dermatology Department, Hospital Universitario Cruces de Bilbao, Bilbao, Spain.
¹² Respiratory Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
¹³ Dermatology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain.
¹⁴ Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
¹⁵ Respiratory Department, Hospital Universitario Germans Trials I Pujol, Barcelona, Spain.
¹⁶ Dermatology Department, Hospital Universitario Germans Trials I Pujol, Barcelona, Spain.
¹⁷ Respiratory Department, Hospital Universitario General de Guadalajara, Guadalajara, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
¹⁸ Dermatology Department, Hospital Universitario General de Guadalajara, Guadalajara, Spain.
¹⁹ Respiratory Department, Hospital Universitario San Juan de Alicante, Alicante, Spain.
²⁰ Respiratory Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
²¹ Respiratory Department, IRBLleida, Lleida, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
²² Respiratory Department, Hospital Universitario de Getafe, Madrid, Spain.
²³ Dermatology Department, Hospital Universitario de Getafe, Madrid, Spain.
²⁴ Dermatology Department, Hospital Valme, Seville, Spain.
²⁵ Respiratory Department, Fundación Jimenez Diaz, Madrid, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
²⁶ Dermatology Department, Fundación Jimenez Diaz, Madrid, Spain.
²⁷ Respiratory Department, Consorcio Sanitario Terrassa, Barcelona, Spain.
²⁸ Dermatology Department, Consorcio Sanitario Terrassa, Barcelona, Spain.
²⁹ Biostatistical Service, BioAraba, Health Research Institute, OSI Araba University Hospital, Basque Health Service, University of the Basque Country, Bilbao, Spain.
³⁰ Respiratory Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
³¹ Dermatology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
³² Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain, and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
³³ Department of Pediatrics, University of Chicago, Chicago, IL.

PMID: 30059679
DOI: 10.1016/j.chest.2018.07.015

Free article

Sleep-Disordered Breathing Is Independently Associated With Increased Aggressiveness of Cutaneous Melanoma: A Multicenter Observational Study in 443 Patients

Miguel Angel Martinez-Garcia et al. Chest. 2018 Dec.

Free article

. 2018 Dec;154(6):1348-1358.

doi: 10.1016/j.chest.2018.07.015. Epub 2018 Jul 27.

Authors

Collaborators

Spanish Sleep Network:
Isabel Betlloch, Manuel Moragon, Esther Pastor, Verónica Velasco, Amaia Urrutia, Cristian Perna, Zully Vásquez, Jose Antonio Aramburu, Aida Muñoz, M Angeles Gonzalez, Joan Dalmau, Rosa M Marti, Ana Mozos, Erika Miranda, Maider Mateos, Paula Rodriguez, M Fernanda Troncoso, Monica de la Peña, Luis Javier Del Pozo, Mónica Gonzalez, Pilar Manchado, Santiago Antonio Juarros, Julian Caballero, Eduardo Alcaraz, Andrea Crespo, Jesús Martín, Lorena Comeche, Martina Alés, Monica Llombart, María Pérez-Crespo, Bienvenido Barreiro, Neus Curco, Olga Cantalejo, Nuria Reyes-Nuñez, Antonio Cruz-Medina, Raquel Catalá, Antonio Azón, Nuria Grau, Sonia Segura

Affiliations

¹ Respiratory Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain. Electronic address: mianmartinezgarcia@gmail.com.
² Respiratory Department, Hospital Valme, Seville, Spain.
³ Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain.
⁴ Dermatology Department, Hospital de Manises, Valencia, Spain.
⁵ Anatomic Pathology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
⁶ Respiratory Department, Hospital General Universitario de Alicante, Alicante, Spain.
⁷ Dermatology Department, Hospital General Universitario de Alicante, Alicante, Spain.
⁸ Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
⁹ Dermatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
¹⁰ Respiratory Department, Hospital Universitario Cruces de Bilbao, Bilbao, Spain.
¹¹ Dermatology Department, Hospital Universitario Cruces de Bilbao, Bilbao, Spain.
¹² Respiratory Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
¹³ Dermatology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain.
¹⁴ Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
¹⁵ Respiratory Department, Hospital Universitario Germans Trials I Pujol, Barcelona, Spain.
¹⁶ Dermatology Department, Hospital Universitario Germans Trials I Pujol, Barcelona, Spain.
¹⁷ Respiratory Department, Hospital Universitario General de Guadalajara, Guadalajara, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
¹⁸ Dermatology Department, Hospital Universitario General de Guadalajara, Guadalajara, Spain.
¹⁹ Respiratory Department, Hospital Universitario San Juan de Alicante, Alicante, Spain.
²⁰ Respiratory Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
²¹ Respiratory Department, IRBLleida, Lleida, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
²² Respiratory Department, Hospital Universitario de Getafe, Madrid, Spain.
²³ Dermatology Department, Hospital Universitario de Getafe, Madrid, Spain.
²⁴ Dermatology Department, Hospital Valme, Seville, Spain.
²⁵ Respiratory Department, Fundación Jimenez Diaz, Madrid, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
²⁶ Dermatology Department, Fundación Jimenez Diaz, Madrid, Spain.
²⁷ Respiratory Department, Consorcio Sanitario Terrassa, Barcelona, Spain.
²⁸ Dermatology Department, Consorcio Sanitario Terrassa, Barcelona, Spain.
²⁹ Biostatistical Service, BioAraba, Health Research Institute, OSI Araba University Hospital, Basque Health Service, University of the Basque Country, Bilbao, Spain.
³⁰ Respiratory Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
³¹ Dermatology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
³² Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain, and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain.
³³ Department of Pediatrics, University of Chicago, Chicago, IL.

PMID: 30059679
DOI: 10.1016/j.chest.2018.07.015

Abstract

Background: Sleep-disordered breathing (SDB) has been associated with a greater incidence and mortality of cancer, although such findings are inconsistent. However, no large studies are currently available to investigate this association in patients with a specific type of cancer. This study seeks to assess potential relationships between SDB severity and aggressiveness markers of cutaneous melanoma.

Methods: Four hundred and forty-three patients with a diagnosis of melanoma underwent a sleep study within 6 months of diagnosis. General demographics were collected, along with melanoma characteristics and polygraphic parameters consisting of the apnea-hypopnea index (AHI) and indices of both continuous and intermittent night-time oxyhemoglobin desaturation (DI4%). An exploration of independent relationships between SDB and various objective melanoma aggressiveness markers (Breslow index, presence of ulceration, presence of regression, mitotic index, stage of severity, damage to the sentinel lymph, and spreading of the melanoma) was performed.

Results: Patients in the upper tertiles of AHI or DI4% were 1.94 (95% CI, 1.14-3.32; P = .022) and 1.93 (95% CI, 1.14-3.26; P = .013) times more likely, respectively, to present with aggressive melanoma (Breslow index > 1 mm) than those in the lowest tertiles of these sleep attributes after adjustment for age, sex, tumor location, and BMI. This association was particularly prominent among patients < 56 years of age with Breslow index > 2 mm. The presence of the additional markers of aggressiveness was also associated with higher AHI and DI4% values.

Conclusions: The severity of SDB was independently associated with greater aggressiveness of cutaneous melanoma, particularly among younger patients.

Keywords: Breslow index; melanoma aggressiveness; sleep apnea; sleep-disordered breathing.

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Sleep-Disordered Breathing Is Independently Associated With Increased Aggressiveness of Cutaneous Melanoma: A Multicenter Observational Study in 443 Patients

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Sleep-Disordered Breathing Is Independently Associated With Increased Aggressiveness of Cutaneous Melanoma: A Multicenter Observational Study in 443 Patients

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