{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T13:06:17Z","timestamp":1792674377508,"version":"4.5.0"},"reference-count":87,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T00:00:00Z","timestamp":1605830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["HL130984 and HL140548."],"award-info":[{"award-number":["HL130984 and HL140548."]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Spanish Ministry of Science, Innovation and Universities","award":["SAF2017-85574-R"],"award-info":[{"award-number":["SAF2017-85574-R"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Obstructive sleep apnoea (OSA) is a prevalent disorder associated with increased cardiovascular, metabolic and neurocognitive morbidity. Recently, an increasing number of basic, clinical and epidemiological reports have suggested that OSA may also increase the risk of cancer, and adversely impact cancer progression and outcomes. This hypothesis is convincingly supported by biological evidence linking certain solid tumours and hypoxia, as well as by experimental studies involving cell and animal models testing the effects of intermittent hypoxia and sleep fragmentation that characterize OSA. However, the clinical and epidemiological studies do not conclusively confirm that OSA adversely affects cancer, even if they hold true for specific cancers such as melanoma. It is likely that the inconclusive studies reflect that they were not specifically designed to test the hypothesis or because of the heterogeneity of the relationship of OSA with different cancer types or even sub-types. This review critically focusses on the extant basic, clinical, and epidemiological evidence while formulating proposed directions on how the field may move forward.<\/jats:p>","DOI":"10.3390\/ijms21228779","type":"journal-article","created":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T09:46:18Z","timestamp":1605865578000},"page":"8779","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Sleep Apnoea Adverse Effects on Cancer: True, False, or Too Many Confounders?"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8195-6036","authenticated-orcid":false,"given":"David","family":"Gozal","sequence":"first","affiliation":[{"name":"Department of Child Health, The University of Missouri School of Medicine, Columbia, MO 65201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Almendros","sequence":"additional","affiliation":[{"name":"Unitat de Biof\u00edsica i Bioenginyeria, Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain"},{"name":"Institut d\u2019Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda I.","family":"Phipps","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Washington School of Public Health, Seattle, WA 98195, USA"},{"name":"Epidemiology Program, Fred Hutchinson Research Cancer Research Center, Seattle, WA 98109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Campos-Rodriguez","sequence":"additional","affiliation":[{"name":"CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain"},{"name":"Respiratory Department, Hospital Valme (Seville, Spain), Institute of Biomedicine of Seville (IBiS), 41014 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7321-1891","authenticated-orcid":false,"given":"Miguel A.","family":"Mart\u00ednez-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Pneumology Department, Sleep-Disordered Breathing and Research Unit, Polytechnic and University La Fe Hospital, 46026 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9084-7824","authenticated-orcid":false,"given":"Ramon","family":"Farr\u00e9","sequence":"additional","affiliation":[{"name":"Unitat de Biof\u00edsica i Bioenginyeria, Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain"},{"name":"Institut d\u2019Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e28326","DOI":"10.4161\/onci.28326","article-title":"Sleep apnea awakens cancer","volume":"3","author":"Gozal","year":"2014","journal-title":"OncoImmunology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.chest.2016.04.029","article-title":"Cancer and OSA: Current evidence from human studies","volume":"150","author":"Barbe","year":"2016","journal-title":"Chest"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.smrv.2015.05.006","article-title":"Obstructive sleep apnea and cancer: Epidemiologic links and theoretical biological constructs","volume":"27","author":"Gozal","year":"2016","journal-title":"Sleep Med. Rev."},{"key":"ref_4","first-page":"15","article-title":"Metabolic adaptation of cancer and immune cells mediated by hypoxia-inducible factors","volume":"1870","author":"Samanta","year":"2018","journal-title":"Biochim. Biophys. Acta (BBA) Bioenerg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Saxena, K., and Jolly, M.K. (2019). Acute vs. Chronic vs. Cyclic Hypoxia: Their differential dynamics, molecular mechanisms, and effects on tumor progression. Biomolecules, 9.","DOI":"10.3390\/biom9080339"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40248-019-0172-9","article-title":"Obstructive sleep apnea and comorbidities: A dangerous liaison","volume":"14","author":"Bonsignore","year":"2019","journal-title":"Multidiscip. Respir. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"R669","DOI":"10.1152\/ajpregu.00036.2018","article-title":"Models of intermittent hypoxia and obstructive sleep apnea: Molecular pathways and their contribution to cancer","volume":"315","author":"Hunyor","year":"2018","journal-title":"Am. J. Physiol. Integr. Comp. Physiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1378\/chest.15-0634","article-title":"Putative links between sleep apnea and cancer","volume":"148","author":"Gozal","year":"2015","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.5665\/SLEEP.1176","article-title":"Tissue oxygenation in brain, muscle, and fat in a rat model of sleep apnea: Differential effect of obstructive apneas and intermittent hypoxia","volume":"34","author":"Almendros","year":"2011","journal-title":"Sleep"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1016\/j.sleep.2014.07.006","article-title":"Intermittent hypoxia upregulates serum VEGF","volume":"15","author":"Weiss","year":"2014","journal-title":"Sleep Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12931-015-0205-7","article-title":"Mitochondrial DNA alteration in obstructive sleep apnea","volume":"16","author":"Lacedonia","year":"2015","journal-title":"Respir. Res."},{"key":"ref_12","first-page":"7","article-title":"Sympathetic and catecholaminergic alterations in sleep apnea with particular emphasis on children","volume":"3","author":"Ehakim","year":"2012","journal-title":"Front. Neurol."},{"key":"ref_13","first-page":"40","article-title":"Altered CD8+ T-Cell Lymphocyte function and tc1 cell stemness contribute to enhanced malignant tumor properties in murine models of sleep apnea","volume":"40","author":"Akbarpour","year":"2016","journal-title":"Sleep"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.resp.2017.08.008","article-title":"Intermittent hypoxia and cancer: Undesirable bed partners?","volume":"256","author":"Almendros","year":"2018","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Martinez, C.-A., Kerr, B., Jin, C., Cistulli, P.A., and Cook, K.M. (2019). Obstructive sleep apnea activates hif-1 in a hypoxia dose-dependent manner in hct116 colorectal carcinoma cells. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20020445"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1158\/0008-5472.CAN-13-3014","article-title":"Fragmented sleep accelerates tumor growth and progression through recruitment of tumor-associated macrophages and tlr4 signaling","volume":"74","author":"Hakim","year":"2014","journal-title":"Cancer Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1164\/rccm.201310-1830OC","article-title":"Intermittent hypoxia-induced changes in tumor-associated macrophages and tumor malignancy in a mouse model of sleep apnea","volume":"189","author":"Almendros","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.3389\/fphys.2018.01556","article-title":"Intermittent hypoxia severity in animal models of sleep apnea","volume":"9","author":"Montserrat","year":"2018","journal-title":"Front. Physiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1164\/rccm.201107-1173OC","article-title":"Sleep fragmentation induces cognitive deficits via nicotinamide adenine dinucleotide phosphate oxidase\u2013dependent pathways in mouse","volume":"184","author":"Nair","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1602111","DOI":"10.1183\/13993003.02111-2016","article-title":"Chronic intermittent hypoxia mimicking sleep apnoea increases spontaneous tumorigenesis in mice","volume":"49","author":"Almendros","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1016\/j.sleep.2012.08.012","article-title":"Obesity and intermittent hypoxia increase tumor growth in a mouse model of sleep apnea","volume":"13","author":"Almendros","year":"2012","journal-title":"Sleep Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1164\/rccm.201805-0892LE","article-title":"Aging reduces intermittent hypoxia\u2013induced lung carcinoma growth in a mouse model of sleep apnea","volume":"198","author":"Torres","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1097\/GME.0000000000001526","article-title":"Lung cancer aggressiveness in an intermittent hypoxia murine model of postmenopausal sleep apnea","volume":"27","author":"Torres","year":"2020","journal-title":"Menopause"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e976057","DOI":"10.4161\/2162402X.2014.976057","article-title":"Reduced NADPH oxidase type 2 activity mediates sleep fragmentation-induced effects on TC1 tumors in mice","volume":"4","author":"Zheng","year":"2015","journal-title":"OncoImmunology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.canlet.2015.03.010","article-title":"Adipose tissue macrophage polarization by intermittent hypoxia in a mouse model of OSA: Effect of tumor microenvironment","volume":"361","author":"Almendros","year":"2015","journal-title":"Cancer Lett."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"556","DOI":"10.18632\/oncotarget.2785","article-title":"Tumor circulating DNA profiling in xenografted mice exposed to intermittent hypoxia","volume":"6","author":"Cortese","year":"2014","journal-title":"Oncotarget"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1016\/j.chest.2016.08.1438","article-title":"Tumor Cell Malignant Properties Are Enhanced by Circulating Exosomes in Sleep Apnea","volume":"150","author":"Almendros","year":"2016","journal-title":"Chest"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"54676","DOI":"10.18632\/oncotarget.10578","article-title":"Circulating exosomes potentiate tumor malignant properties in a mouse model of chronic sleep fragmentation","volume":"7","author":"Khalyfa","year":"2016","journal-title":"Oncotarget"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"44693","DOI":"10.1038\/srep44693","article-title":"Role of Cyclooxygenase-2 on Intermittent Hypoxia-Induced Lung Tumor Malignancy in a Mouse Model of Sleep Apnea","volume":"7","author":"Campillo","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1007\/s12094-018-1955-8","article-title":"Anti-tumor effect of endostatin in a sleep-apnea mouse model with tumor","volume":"21","author":"Zhang","year":"2018","journal-title":"Clin. Transl. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Guo, X., Liu, Y., Kim, J.L., Kim, E.Y., Kim, E.Q., Jansen, A., Li, K., Chan, M., Keenan, B.T., and Conejo-Garcia, J. (2019). Effect of cyclical intermittent hypoxia on Ad5CMVCre induced solitary lung cancer progression and spontaneous metastases in the KrasG12D+; p53fl\/fl; myristolated p110fl\/fl ROSA-gfp mouse. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0212930"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"97","DOI":"10.21037\/atm.2019.01.44","article-title":"Intermittent hypoxia enhances the tumor programmed death ligand 1 expression in a mouse model of sleep apnea","volume":"7","author":"Huang","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1183\/09031936.00185110","article-title":"Intermittent hypoxia enhances cancer progression in a mouse model of sleep apnoea","volume":"39","author":"Almendros","year":"2011","journal-title":"Eur. Respir. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.resp.2013.03.001","article-title":"Intermittent hypoxia increases melanoma metastasis to the lung in a mouse model of sleep apnea","volume":"186","author":"Almendros","year":"2013","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_35","first-page":"209","article-title":"Enhanced expression of melanoma progression markers in mouse model of sleep apnea","volume":"22","author":"Perini","year":"2016","journal-title":"Rev. Port. Pneumol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"61592","DOI":"10.18632\/oncotarget.18644","article-title":"Accelerated tumor growth under intermittent hypoxia is associated with hypoxia-inducible factor-1-dependent adaptive responses to hypoxia","volume":"8","author":"Yoon","year":"2017","journal-title":"Oncotarget"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s12931-018-0727-x","article-title":"Intermittent hypoxia promotes melanoma lung metastasis via oxidative stress and inflammation responses in a mouse model of obstructive sleep apnea","volume":"19","author":"Li","year":"2018","journal-title":"Respir. Res."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Vilaseca, A., Campillo, N., Torres, M., Musquera, M., Gozal, D., Montserrat, J.M., Alcaraz, A., Touijer, K.A., Farr\u00e9, R., and Almendros, I. (2017). Intermittent hypoxia increases kidney tumor vascularization in a murine model of sleep apnea. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0179444"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4214","DOI":"10.1038\/s41388-018-0259-3","article-title":"Intermittent hypoxia induces a metastatic phenotype in breast cancer","volume":"37","author":"Chen","year":"2018","journal-title":"Oncogene"},{"key":"ref_40","first-page":"7715","article-title":"Hypoxia-inducible factor 1 mediates intermittent hypoxia-induced migration of human breast cancer MDA-MB-231 cells","volume":"14","author":"Liu","year":"2017","journal-title":"Oncol. Lett."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1002\/mc.22957","article-title":"Intermittent hypoxia promotes carcinogenesis in azoxymethane and dextran sodium sulfate-induced colon cancer model","volume":"58","author":"Yoon","year":"2019","journal-title":"Mol. Carcinog."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"R678","DOI":"10.1152\/ajpregu.00388.2018","article-title":"Chronic intermittent hypoxia enhances disease progression in myeloma-resistant mice","volume":"316","author":"Ali","year":"2019","journal-title":"Am. J. Physiol. Integr. Comp. Physiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1038\/s41598-020-58906-7","article-title":"Intermittent hypoxia exacerbates tumor progression in a mouse model of lung cancer","volume":"10","author":"Kang","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.bbrc.2019.10.145","article-title":"ALKBH5-m6A-FOXM1 signaling axis promotes proliferation and invasion of lung adenocarcinoma cells under intermittent hypoxia","volume":"521","author":"Chao","year":"2020","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1165\/rcmb.2018-0412LE","article-title":"Effects of sustained and intermittent hypoxia on human lung cancer cells","volume":"61","author":"Marhuenda","year":"2019","journal-title":"Am. J. Respir. Cell Mol. Biol."},{"key":"ref_46","first-page":"457","article-title":"Intra-tumour diversification in colorectal cancer at the single-cell level","volume":"556","author":"Roerink","year":"2018","journal-title":"Nat. Cell Biol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1164\/rccm.201209-1671OC","article-title":"Association between obstructive sleep apnea and cancer incidence in a large multicenter spanish cohort","volume":"187","author":"Martinez","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1164\/rccm.201201-0130OC","article-title":"Sleep-disordered breathing and cancer mortality","volume":"186","author":"Nieto","year":"2012","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s10555-007-9055-1","article-title":"Hypoxia in cancer: Significance and impact on clinical outcome","volume":"26","author":"Vaupel","year":"2007","journal-title":"Cancer Metastasis Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1700833","DOI":"10.1183\/13993003.00833-2017","article-title":"Hypoxia-induced PD-L1\/PD-1 crosstalk impairs T-cell function in sleep apnoea","volume":"50","author":"Toledano","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.5665\/sleep.5062","article-title":"Invariant natural killer t cell deficiency and functional impairment in sleep apnea: Links to cancer comorbidity","volume":"38","author":"Gaoatswe","year":"2015","journal-title":"Sleep"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"709","DOI":"10.5665\/sleep.3574","article-title":"Treatment of obstructive sleep apnea alters cancer-associated transcriptional signatures in circulating leukocytes","volume":"37","author":"Gharib","year":"2014","journal-title":"Sleep"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.smrv.2018.08.009","article-title":"Obstructive sleep apnea and the metabolic syndrome: The road to clinically-meaningful phenotyping, improved prognosis, and personalized treatment","volume":"42","author":"Gaines","year":"2018","journal-title":"Sleep Med. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"216","DOI":"10.2174\/1568009619666191116095847","article-title":"Effects of intermittent hypoxia on expression of glucose metabolism genes in mcf7 breast cancer cell line","volume":"20","author":"Jarrar","year":"2020","journal-title":"Curr. Cancer Drug Targets"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Gao, J., Cao, H., Zhang, Q., and Wang, B. (2020). The effect of intermittent hypoxia and fecal microbiota of OSAS on genes associated with colorectal cancer. Sleep Breath., 1\u201313.","DOI":"10.1007\/s11325-020-02204-z"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1111\/resp.13470","article-title":"Age-dependent hypoxia-induced PD-L1 upregulation in patients with obstructive sleep apnoea","volume":"24","author":"Toledano","year":"2019","journal-title":"Respirology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s11912-018-0732-8","article-title":"The world of melanoma: Epidemiologic, genetic, and anatomic differences of melanoma across the globe","volume":"20","author":"Dimitriou","year":"2018","journal-title":"Curr. Oncol. Rep."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1164\/rccm.201903-0577PP","article-title":"Cancer and sleep apnea: Cutaneous melanoma as a case study","volume":"200","author":"Almendros","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e492","DOI":"10.1111\/ijd.12904","article-title":"Sleep duration and sleep-disordered breathing and the risk of melanoma among US women and men","volume":"54","author":"Cohen","year":"2015","journal-title":"Int. J. Dermatol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.5665\/sleep.6004","article-title":"Sleep apnea and cancer: Analysis of a nationwide population sample","volume":"39","author":"Gozal","year":"2016","journal-title":"Sleep"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s10552-018-1073-5","article-title":"Sleep apnea and subsequent cancer incidence","volume":"29","author":"Sillah","year":"2018","journal-title":"Cancer Causes Control."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1183\/09031936.00115413","article-title":"Association between sleep disordered breathing and aggressiveness markers of malignant cutaneous melanoma","volume":"43","author":"Nagore","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1016\/j.chest.2018.07.015","article-title":"Sleep-disordered breathing is independently associated with increased aggressiveness of cutaneous melanoma","volume":"154","author":"Nagore","year":"2018","journal-title":"Chest"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.sleep.2014.01.020","article-title":"Obstructive sleep apnea is associated with cancer mortality in younger patients","volume":"15","author":"Masdeu","year":"2014","journal-title":"Sleep Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1801298","DOI":"10.1183\/13993003.01298-2018","article-title":"Soluble PD-L1 is a potential biomarker of cutaneous melanoma aggressiveness and metastasis in obstructive sleep apnoea patients","volume":"53","author":"Nagore","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/j.sleep.2014.05.026","article-title":"Sleep apnea and the subsequent risk of breast cancer in women: A nationwide population-based cohort study","volume":"15","author":"Chang","year":"2014","journal-title":"Sleep Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"495","DOI":"10.5664\/jcsm.5674","article-title":"Pre-diagnostic sleep duration and sleep quality in relation to subsequent cancer survival","volume":"12","author":"Phipps","year":"2016","journal-title":"J. Clin. Sleep Med."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Campos-Rodriguez, F., Cruz-Medina, A., Selma, M.J., Rodriguez-De-La-Borbolla-Artacho, M., Sanchez-Vega, A., Ripoll-Orts, F., Almeida-Gonzalez, C.V., and Martinez-Garcia, M.A. (2018). Association between sleep-disordered breathing and breast cancer aggressiveness. PLoS ONE, 13.","DOI":"10.1183\/13993003.congress-2018.PA427"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-019-55551-7","article-title":"Association between obstructive sleep apnoea and breast cancer: The Korean National Health Insurance Service Data 2007\u20132014","volume":"9","author":"Choi","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.sleep.2019.05.011","article-title":"Obstructive sleep apnea and nocturnal hypoxemia are associated with an increased risk of lung cancer","volume":"63","author":"Seijo","year":"2019","journal-title":"Sleep Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12890-018-0645-1","article-title":"Sleep-disordered breathing in patients with newly diagnosed lung cancer","volume":"18","author":"Dreher","year":"2018","journal-title":"BMC Pulm. Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"21567","DOI":"10.18632\/oncotarget.15372","article-title":"Target of obstructive sleep apnea syndrome merge lung cancer: Based on big data platform","volume":"8","author":"Li","year":"2017","journal-title":"Oncotarget"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1007\/s11596-019-2075-6","article-title":"Relationship between Occurrence and Progression of Lung Cancer and Nocturnal Intermittent Hypoxia, Apnea and Daytime Sleepiness","volume":"39","author":"Liu","year":"2019","journal-title":"Curr. Med. Sci."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"681","DOI":"10.5665\/sleep.2626","article-title":"Associations of self-reported sleep duration and snoring with colorectal cancer risk in men and women","volume":"36","author":"Zhang","year":"2013","journal-title":"Sleep"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.gie.2016.07.061","article-title":"Obstructive sleep apnea is associated with an increased risk of colorectal neoplasia","volume":"85","author":"Lee","year":"2017","journal-title":"Gastrointest. Endosc."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1007\/s11325-016-1336-x","article-title":"Obstructive sleep apnea and urological comorbidities in males: A population-based study","volume":"20","author":"Chung","year":"2016","journal-title":"Sleep Breath."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s00345-016-1830-6","article-title":"Obstructive sleep apnea and Fuhrman grade in patients with clear cell renal cell carcinoma treated surgically","volume":"35","author":"Vilaseca","year":"2017","journal-title":"World J. Urol."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Molin, M.D., Brant, A., Blackford, A.L., Griffin, J.F., Shindo, K., Barkley, T., Rezaee, N., Hruban, R.H., Wolfgang, C.L., and Goggins, M. (2016). Obstructive sleep apnea and pathological characteristics of resected pancreatic ductal adenocarcinoma. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0164195"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.sleep.2013.11.782","article-title":"Sleep apnea increased incidence of primary central nervous system cancers: A nationwide cohort study","volume":"15","author":"Chen","year":"2014","journal-title":"Sleep Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"106455","DOI":"10.1016\/j.leukres.2020.106455","article-title":"The incidence of non-Hodgkin lymphoma is increased in patients with obstructive sleep apnea","volume":"98","author":"Choi","year":"2020","journal-title":"Leuk. Res."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"355","DOI":"10.5664\/jcsm.3600","article-title":"Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the busselton health study cohort","volume":"10","author":"Marshall","year":"2014","journal-title":"J. Clin. Sleep Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.7150\/jca.12490","article-title":"Risk of cancer in patients with insomnia, parasomnia, and obstructive sleep apnea: A nationwide nested case-control study","volume":"6","author":"Fang","year":"2015","journal-title":"J. Cancer"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Huang, T., Lin, B.M., Stampfer, M.J., Schernhammer, E.S., Saxena, R., Tworoger, S.S., and Redline, S. (2020). Associations of self-reported obstructive sleep apnea with total and site-specific cancer risk in older women: A prospective study. Sleep.","DOI":"10.1093\/sleep\/zsaa198"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1177\/0194599819900487","article-title":"The association of sleep apnea and cancer in veterans","volume":"162","author":"Jara","year":"2020","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e12427","DOI":"10.1111\/ecc.12427","article-title":"Obstructive sleep apnoea and the incidence and mortality of cancer: A meta-analysis","volume":"26","author":"Zhang","year":"2015","journal-title":"Eur. J. Cancer Care"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1503\/cmaj.140238","article-title":"Obstructive sleep apnea and the prevalence and incidence of cancer","volume":"186","author":"Kendzerska","year":"2014","journal-title":"Can. Med. Assoc. J."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1093\/sleep\/20.9.705","article-title":"Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women","volume":"20","author":"Young","year":"1997","journal-title":"Sleep"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/21\/22\/8779\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:34:51Z","timestamp":1760178891000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/21\/22\/8779"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,20]]},"references-count":87,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["ijms21228779"],"URL":"https:\/\/doi.org\/10.3390\/ijms21228779","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,20]]}}}