Obstructive sleep apnoea (OSA) contributes to an increased risk of cardiovascular disease (CVD) events for patients with cancer, and this risk increase persists regardless of obesity status and is more pronounced in women, according to a retrospective study.
In a large cohort of adult patients with cancer, the primary outcome of composite CVD events occurred in 34 percent of those with OSA vs 23 percent of those without OSA. This translated to a 27-percent greater risk of the composite CVD outcome among cancer patients with OSA (hazard ratio [HR], 1.27, 95 percent confidence interval [CI], 1.26–1.28), reported first author Dr Ehimen Aneni from the Yale School of Medicine, New Haven, Connecticut, US, and colleagues. [J Am Heart Assoc 2026;doi:10.1161/JAHA.125.045805]
When the events in the composite outcome were assessed individually as part of the secondary endpoints, the highest risk observed among patients with OSA was for heart failure (HR, 1.80, 95 percent CI, 1.78–1.83), followed by atrial fibrillation/flutter (HR, 1.71, 95 percent CI, 1.69–1.74), myocardial infarction (HR, 1.42, 95 percent CI, 1.39–1.45), and ischaemic stroke (HR, 1.41, 95 percent CI, 1.38–1.44). However, the risk of total mortality was 16-percent lower among patients with vs without OSA (HR, 0.84, 95 percent CI, 0.83–0.85).
In subgroup analyses, “a striking association was seen among women with cancer in whom the presence of OSA raised their risk of heart failure by nearly twofold (HR, 1.94, 95 percent CI, 1.89–1.98),” Aneni and colleagues noted. “This finding was echoed in the subgroup of those with breast cancer,” which is a female-predominant population, they added.
“OSA [also had an] additive CVD risk in people with cancer even in the absence of obesity, although the risk was attenuated,” said Aneni and colleagues. For instance, people with OSA without obesity had a 15-percent greater risk of the primary outcome (HR, 1.15, 95 percent CI, 1.12–1.17), whereas people with obesity with OSA had a 28-percent increased risk (HR, 1.28, 95 percent CI, 1.26–1.29).
Overall, the evidence from this retrospective cohort study “support routine OSA screening and potential early intervention in oncology populations to mitigate CVD risk,” according to the authors.
“Future studies will need to account for OSA severity and symptom profile, established and emerging OSA therapies such as continuous positive airway pressure, Inspire, GLP‐1 (glucagon‐like peptide‐1) receptor agonist, and SGLT2 (sodium‐glucose cotransporter‐2) inhibitor, cancer type, and cancer therapy,” they said.
The retrospective cohort study was conducted using the TriNetX database. Aneni and colleagues identified more than 4 million adults at least 40 years of age who had a diagnosis of cancer. Cancer patients with OSA and those without OSA were propensity score‐matched based on several characteristics including race, age at index event (ie, cancer diagnosis), weight status, diabetes, chronic kidney disease, hypertension, lipid and lipoprotein disorders, pulmonary heart disease and diseases of the pulmonary circulation, and secondary and unspecified neoplasms of the lymph nodes, respiratory and digestive organs, and of unspecified sites.
The matched cohort included 629,114 cancer patients each in the OSA group and no-OSA group. The average age of the patients was 65 years, with around 40 percent female and more than 80 percent White. The prevalence of depressive episodes and insomnia remained greater in the OSA group than in the no-OSA group. Patients were followed for a mean of 5 years in the OSA group and 3.8 years in the no-OSA group.