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Miguel Ángel Martínez-García, MD, PhD; Francisco Campos-Rodriguez, MD, PhD; Ferrán Barbé, MD, PhD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

aRespiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain

bHospital Universitario Valme, Seville, Spain

cRespiratory Department, Institut de Recerca Biomédica (IRBLleida), Leida, Spain

dCIBER de enfermedades respiratorias, Madrid, Spain

CORRESPONDENCE TO: Miguel Ángel Martínez-García, MD, PhD, Pneumology Department, Hospital Universitario y Politécnico La Fe, Bulevar Sur s/n, 46012, Valencia, Spain


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1412. doi:10.1016/j.chest.2016.08.1471
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At the outset, we wish to thank Dr Marvisi for his interest in our article. As the authors of the letter have stated, in the past few years some outstanding research groups have described other pathophysiological pathways linking OSA with cancer, some orchestrated by hypoxia,,, and some by sleep fragmentation.,,,, Some of these pathways are related to alterations to the immune system in macrophages/monocytes, natural killer cells, lymphocytes, and other immune cells.,,,,, Interesting studies and reviews of the role of microvesicles/exosomes and the impact on the sympathetic/catecholaminergic system and other pathophysiological pathways have recently been published.,,, For this reason, we decided to focus our review on clinical studies in humans that deal with the relationship between OSA and cancer incidence and mortality. In fact, we only outlined some basic ideas about pathophysiology in the introductory paragraph of the review, and the last paragraph was dedicated to the limitations of the clinical studies. We encourage the authors to read the excellent revisions made by Gozal et al,, for further information, one of which was recently published in CHEST.

References

Marvisi M. . Cancer and OSA: beyond hypoxia. Chest. 2016;150:1411-1412 [PubMed]journal
 
Gozal D. .Almendros I. .Hakim F. . Sleep apnea awakens cancer. A unifying immunological hypothesis. Oncoimmunology. 2014;3:e28326- [PubMed]journal. [CrossRef] [PubMed]
 
Gozal D. .Farré R. .Nieto F.J. . Obstructive sleep apnea and cancer: epidemiological links and theoretical biological constructs. Sleep Med Rev. 2016;27:43-55 [PubMed]journal. [CrossRef] [PubMed]
 
Gozal D. .Farré R. .Nieto J. . Putative links between sleep apnea and cancer. From hypothesis to evolving evidence. Chest. 2015;148:1140-1147 [PubMed]journal. [CrossRef] [PubMed]
 
Almendros I. .Wang Y. .Becker L. .et al Intermittent hypoxia-induced changes in tumor associated macrophages and tumor malignancy in a mouse model of sleep apnea. Am J Respir Crit Care Med. 2014;189:593-601 [PubMed]journal. [CrossRef] [PubMed]
 
Hakim F. .Wang Y. .Zhang S.X. .et al Fragmented sleep accelerates tumor growth and progression through recruitment of tumor associated macrophages and TLR4 signaling. Cancer Res. 2014;74:1329-1337 [PubMed]journal. [CrossRef] [PubMed]
 
Gaoatswe G. .Kent B.D. .Corrigan M.A. .et al Invariant natural killer T cell deficiency and functional impairment in sleep apnea: links to cancer comorbidity. Sleep. 2015;138:1629-1634 [PubMed]journal
 
Khalifa A, Almendros I, Gileles-Hillel A, et al. Circulating exosomes potentiate tumor malignant properties in a mouse of chronic sleep fragmentation [published online ahead of print July 13, 2016].Oncotarget.http://dx.doi.org/10.18632/oncotarget.10578.
 
Martínez García M.A. .Campos-Rodriguez F. .Barbé F. . Cancer and OSA: current evidence from human studies. Chest. 2016;150:451-463 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

References

Marvisi M. . Cancer and OSA: beyond hypoxia. Chest. 2016;150:1411-1412 [PubMed]journal
 
Gozal D. .Almendros I. .Hakim F. . Sleep apnea awakens cancer. A unifying immunological hypothesis. Oncoimmunology. 2014;3:e28326- [PubMed]journal. [CrossRef] [PubMed]
 
Gozal D. .Farré R. .Nieto F.J. . Obstructive sleep apnea and cancer: epidemiological links and theoretical biological constructs. Sleep Med Rev. 2016;27:43-55 [PubMed]journal. [CrossRef] [PubMed]
 
Gozal D. .Farré R. .Nieto J. . Putative links between sleep apnea and cancer. From hypothesis to evolving evidence. Chest. 2015;148:1140-1147 [PubMed]journal. [CrossRef] [PubMed]
 
Almendros I. .Wang Y. .Becker L. .et al Intermittent hypoxia-induced changes in tumor associated macrophages and tumor malignancy in a mouse model of sleep apnea. Am J Respir Crit Care Med. 2014;189:593-601 [PubMed]journal. [CrossRef] [PubMed]
 
Hakim F. .Wang Y. .Zhang S.X. .et al Fragmented sleep accelerates tumor growth and progression through recruitment of tumor associated macrophages and TLR4 signaling. Cancer Res. 2014;74:1329-1337 [PubMed]journal. [CrossRef] [PubMed]
 
Gaoatswe G. .Kent B.D. .Corrigan M.A. .et al Invariant natural killer T cell deficiency and functional impairment in sleep apnea: links to cancer comorbidity. Sleep. 2015;138:1629-1634 [PubMed]journal
 
Khalifa A, Almendros I, Gileles-Hillel A, et al. Circulating exosomes potentiate tumor malignant properties in a mouse of chronic sleep fragmentation [published online ahead of print July 13, 2016].Oncotarget.http://dx.doi.org/10.18632/oncotarget.10578.
 
Martínez García M.A. .Campos-Rodriguez F. .Barbé F. . Cancer and OSA: current evidence from human studies. Chest. 2016;150:451-463 [PubMed]journal. [CrossRef] [PubMed]
 
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