WOMEN WITH SLEEP APNEA HAVE INCREASED RISK OF CANCER

WOMEN WITH SLEEP APNEA HAVE INCREASED RISK OF CANCER

By Charles Kravitz, DDS

We know that men are more at risk of developing sleep apnea. But for women who suffer from OSA the risk of developing cancer is more than your male counterparts, says a recent research published in the European Respiratory Journal. The scientists collected data of 20,000 patients with OSA. It was found that a large percent of these patients were later diagnosed with cancer.

HOW OSA INFLUENCES CANCER

The studies show that people suffering from sleep-disordered breathing have an increased risk of developing cancer and are up to five times more likely to die from the disease.
Once again the culprit is HYPOXIA. The lack of oxygen (hypoxia) caused by untreated Obstructive Sleep Apnea (OSA) can be a catalyst for a process called neovascularization (the creation of new blood vessels), giving a blood supply that can encourage tumor growth.
 Two of the key hormones that fall out of balance—cortisol and melatonin—are critical for maintaining a healthy immune system (cortisol) and for regulating the body’s circadian system (melatonin). In addition, this neurochemical balance can lead to body-wide (systemic) inflammation.


How does this relate to cancer?
Without a healthy immune system, the body can struggle to fight off the aggressive cellular behaviors that can lead to tumors. 
With an imbalance in circadian rhythms as the result of decreased melatonin, the body produces higher amounts of other substances that are risk factors for cancer (for women, higher estrogen can lead to breast cancer, and for men, higher estrogen can lead to prostate, bowel, lung, and bladder cancer). 


Systemic inflammation causes oxidative stress to the organs. Oxidation is a breakdown of tissues that is the consequence of long-term inflammation; oxidative stress refers to the damage that results from unchecked systemic inflammation, which makes it easier for cancer—an opportunistic disease—to establish itself wherever the body is most vulnerable.
Cancer cells thrive in a low oxygen environment. Hospitals will put a patient on oxygen if their O2 levels drop below 92. Untreated OSA can cause oxygen levels to drop anywhere from the 90’s, 80’s and even in the 50’s.


Sleep apnea causes sustained low blood oxygen.

One of the biggest problems with sleep apnea is the way in which it deprives the body of necessary oxygen. Frequent apneas (pauses in breathing that last at least 10 seconds, but often last much longer) lead to nocturnal intermittent hypoxia. Dentists perform exams of  patient’s mouth, neck, and airway on a regular basis while screening for oral cancer. These health screenings are important, lifesaving moments in a patient’s health journey– we can do that with a similarly deadly condition like untreated sleep apnea.


Detecting OSA and leading the way for treatment can add YEARS to a  patient’s lifespan while significantly improving quality of life. Both cancer and OSA have symptoms that can be easily recognized in the chair during a regular checkup. While checking the mouth for masses and swelling, you can also check on the Mallampati score  and be alert to possible concerns you may have. 
Sources: American Sleep Apnea Association, Centers for Disease Control, Mayo Clinic, National Institutes of Health, National Sleep Foundation, The New York Times, Wisconsin Cohort Study, World Health Organization

DIAGNOSING OSA IN WOMEN: The differences

SPECIAL CONSIDERATIONS IN DIAGNOSING OSA FOR WOMEN
According to an article in the European Respiratory Journal, “Obstructive sleep apnea occurs in 50% of females aged 20-70 years. 20% of females have moderate and 6% severe sleep apnea.” 
Swedish scientist Dr. Karl Franklin and his team set out to find out how prevalent sleep apnea is among women and how often symptoms occur. Out of a population-based random sample of 10,000 women between the ages of 20 and 70 years, they gathered data on 400 of them. The test group were given questionnaires which included several questions regarding their sleeping habits and sleep quality. They also underwent overnight polysomnography.

WOMEN ARE LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA

Women with sleep apnea are less likely to be diagnosed compared to men. In studies of patients registering for evaluation for sleep apnea, the ratio of men to women has sometimes been extremely lopsided, with 8 or 9 men diagnosed with obstructive sleep apnea (OSA) for each woman found to have (OSA). However, we know from studies in the general population that the actual ratio is likely to be closer to 2 or 3 men with OSA for each woman who has the condition.

Women make up about 45 percent of sleep study referrals and most sleep studies are still done to screen for sleep apnea.

WHY ARE WOMEN LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA?

First, there is an unfortunate predefined notion of the make-up of a sleep apnea patient. The stereotype is a middle-age, overweight or obese male. Physicians may not be thinking of this OSA diagnosis when the patient is female. Second, women may present with slightly different symptoms than the “classic” symptoms of snoring, witnessed breathing pauses at night and excessive sleepiness during the day.

Instead, women may present with fatigue, insomnia, disrupted sleep, chronic fatigue and depression morning headaches, mood disturbances or other symptoms that may suggest reasons other than OSA for their symptoms. Because these symptoms are not specific for OSA, women may be misdiagnosed and are less likely to be referred to a sleep study for further evaluation. Another problem is that women with sleep apnea have more subtle breathing disturbances and are more likely to have REM-related apneas, so they may be tougher to diagnose.

WOMAN SNORING 5-25-15

SOME DIFFERENCES IN SYMPTOMS BETWEEN MEN AND WOMEN

Sleep apnea in females is related to age, obesity and hypertension but not to daytime sleepiness. 

The “classic” symptoms of OSA are snoring, witnessed apneas and daytime sleepiness, but women may not experience these things. Weight gain, depression, waking up gasping for breath, hypertension, and dry throat in the morning may be tip-offs for women that they may need an evaluation.

Women who are obese, pregnant women, and post-menopausal women all have a greater risk for OSA. Finally, women with the endocrine disorder, polycystic ovary syndrome, are more likely to have sleep apnea even after controlling for weight and should seek clinical evaluation.

THE DIFFERENCES BETWEEN OSA AND HYPERTENSION IN WOMEN AND MEN

Obstructive sleep apnea is a significant risk factor for heart disease . The prevalence of hypertension in people with sleep apnea ranges between 30-70 percent and is similar in men and women. However, when taking body mass index (BMI) into consideration, some gender differences emerge: men with OSA who are markedly obese (BMI > 37) have a two-fold higher risk of hypertension than obese women with OSA.

THE DIFFERENCES BETWEEN OSA AND DIABETES IN WOMEN AND MEN

Women with OSA tend to be more obese and have lower AHI  than males; however, studies have also suggested that women may have a higher mortality.   OSA is associated with an increased risk for the development of type 2 diabetes independent of obesity.

Women who are obese, pregnant women, and post-menopausal women all have a greater risk for OSA. Finally, women with the endocrine disorder, polycystic ovary syndrome, are more likely to have sleep apnea even after controlling for weight and should seek clinical evaluation.

COMMON SLEEP APNEA MISDIAGNOSES

Women are often diagnosed in error with one of the following conditions, rather than sleep apnea.

  • Anemia
  • Cardiac or pulmonary illnesses
  • Depression
  • Diabetes
  • Fatigue from overwork
  • Fibromyalgia
  • Hypertension
  • Hypochondria
  • Hypothyroidism
  • Insomnia
  • Menopausal changes
  • Obesity
  • Sources
  • Dr. Karl Franklin, European Respiratory Journal
  • Grace W. Pien MD, MS, assistant professor of medicine, divisions of Sleep Medicine and Pulmonary and Critical Care at the University of Pennsylvania School of Medicine.
  • Nancy A. Collop , MD, medical director at Johns Hopkins Hospital Sleep Disorders Center and associate professor of medicine at Hopkins’ Division of Pulmonary and Critical Care Medicine in Baltimore, Md .
  • Fiona C. Baker, PhD, sleep physiologist, Center for Health Sciences, SRI International, in Menlo Park, Calif.
  • Anita L. Blosser, MD, with Duke Primary Care at the Henderson Family Medicine Clinic in Henderson, N.C.
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