Abstract：
OSA has been associated with increased incidence and aggressiveness of melanoma. However, the long-term impact of OSA and CPAP treatment on the prognosis of melanoma remains unexplored.
Are OSA and CPAP treatment associated independently with a poor prognosis for cutaneous melanoma?
Four hundred forty-three patients with a diagnosis of cutaneous melanoma (2012-2015) underwent a sleep study within 6 months of diagnosis. The main 5-year outcome of the study was a composite of melanoma recurrence, metastasis, or mortality. Patients were divided into four groups: baseline apnea-hypopnea index (AHI) of fewer than 10 events/h (no OSA; control group), OSA treated with CPAP and good adherence, untreated or poor CPAP adherence in moderate (AHI, 10-29 events/h), and severe OSA (AHI, ≥ 30 events/h). Survival analysis was used to determine the independent role of OSA and CPAP treatment on melanoma composite outcome.
Three hundred ninety-one patients (88.2%) were available for analysis at 5-year follow-up (mean age, 65.1 ± 15.2 years; 49% male; Breslow index, 1.7 ± 2.5 mm). One hundred thirty-nine patients had AHI of fewer than 10 events/h (control group); 78 patients with OSA were adherent to CPAP; and 124 and 50 patients had moderate and severe OSA, respectively, without CPAP treatment. Median follow-up was 60 months (interquartile range, 51-74 months). During follow-up, 32 relapses, 53 metastases, and 52 deaths occurred (116 patients showed at least one of the main composite outcomes). After adjusting for age, sex, sentinel lymph nodes affected at diagnosis, BMI, diabetes, nighttime with an oxygen saturation below 90%, Breslow index, Epworth sleepiness scale scores, and melanoma treatment, moderate (hazard ratio [HR], 2.45; 95% CI, 1.09-5.49) and severe OSA (HR, 2.96; 95% CI, 1.36-6.42) were associated with poorer prognosis of melanoma compared with the control group. However, good adherence to CPAP avoided this excess risk (HR, 1.66; 95% CI, 0.71-3.90).
Moderate to severe untreated OSA is an independent risk factor for poor prognosis of melanoma. Treatment with CPAP is associated with improved melanoma outcomes compared with untreated moderate to severe OSA.
Are OSA and CPAP treatment associated independently with a poor prognosis for cutaneous melanoma?
Four hundred forty-three patients with a diagnosis of cutaneous melanoma (2012-2015) underwent a sleep study within 6 months of diagnosis. The main 5-year outcome of the study was a composite of melanoma recurrence, metastasis, or mortality. Patients were divided into four groups: baseline apnea-hypopnea index (AHI) of fewer than 10 events/h (no OSA; control group), OSA treated with CPAP and good adherence, untreated or poor CPAP adherence in moderate (AHI, 10-29 events/h), and severe OSA (AHI, ≥ 30 events/h). Survival analysis was used to determine the independent role of OSA and CPAP treatment on melanoma composite outcome.
Three hundred ninety-one patients (88.2%) were available for analysis at 5-year follow-up (mean age, 65.1 ± 15.2 years; 49% male; Breslow index, 1.7 ± 2.5 mm). One hundred thirty-nine patients had AHI of fewer than 10 events/h (control group); 78 patients with OSA were adherent to CPAP; and 124 and 50 patients had moderate and severe OSA, respectively, without CPAP treatment. Median follow-up was 60 months (interquartile range, 51-74 months). During follow-up, 32 relapses, 53 metastases, and 52 deaths occurred (116 patients showed at least one of the main composite outcomes). After adjusting for age, sex, sentinel lymph nodes affected at diagnosis, BMI, diabetes, nighttime with an oxygen saturation below 90%, Breslow index, Epworth sleepiness scale scores, and melanoma treatment, moderate (hazard ratio [HR], 2.45; 95% CI, 1.09-5.49) and severe OSA (HR, 2.96; 95% CI, 1.36-6.42) were associated with poorer prognosis of melanoma compared with the control group. However, good adherence to CPAP avoided this excess risk (HR, 1.66; 95% CI, 0.71-3.90).
Moderate to severe untreated OSA is an independent risk factor for poor prognosis of melanoma. Treatment with CPAP is associated with improved melanoma outcomes compared with untreated moderate to severe OSA.
摘要：
背景：阻塞性睡眠呼吸暂停（OSA）与黑色素瘤的发病率和侵袭性增加有关。然而,OSA和CPAP治疗对黑色素瘤预后的长期影响仍未被研究.
目的：OSA和CPAP治疗与皮肤黑色素瘤的不良预后独立相关吗？
方法：443例诊断为皮肤黑色素瘤的患者（2012-2015年）在诊断后6个月内接受了睡眠研究。主要研究5年结果是黑色素瘤复发的复合结果，转移或死亡。患者分为4组：基线AHI<10事件/h（无OSA，对照组)，使用CPAP治疗的OSA和良好的依从性，未经治疗或CPAP依从性差，中度（AHI：10-29事件/h）和重度OSA（AHI≥30事件/h）。生存分析用于确定OSA和CPAP治疗对黑色素瘤复合结局的独立作用。
结果：391例患者（88.2％）在5年随访时可用于分析（平均年龄：65.1±15.2岁；男性占49％；Breslow指数：1.7±2.5毫米）。139例患者AHI<10（对照）；78例OSA患者坚持CPAP；124例和50例中度和重度OSA患者分别没有CPAP。中位随访时间为60(51-74)个月。随访期间有32例复发，53例转移和52例死亡（116例患者至少有一个主要复合结局）。在调整了年龄之后,性别,前哨淋巴结在诊断时受到影响，身体质量指数,糖尿病,Tsat90%,Breslow指数,Epworth嗜睡量表,和黑色素瘤治疗，中等(HR，2.45；95CI：1.09-5.49）和严重OSA（HR，2.96;95CI：1.36-6.42）与对照组相比，黑色素瘤的预后较差。然而,良好的CPAP依从性避免了这种额外的风险(HR，1.66；95CI：0.71-3.90）。
结论：中度至重度未经治疗的OSA是黑色素瘤预后不良的独立危险因素。与未经治疗的中度至重度OSA相比，CPAP治疗与改善的黑色素瘤预后相关。
目的：OSA和CPAP治疗与皮肤黑色素瘤的不良预后独立相关吗？
方法：443例诊断为皮肤黑色素瘤的患者（2012-2015年）在诊断后6个月内接受了睡眠研究。主要研究5年结果是黑色素瘤复发的复合结果，转移或死亡。患者分为4组：基线AHI<10事件/h（无OSA，对照组)，使用CPAP治疗的OSA和良好的依从性，未经治疗或CPAP依从性差，中度（AHI：10-29事件/h）和重度OSA（AHI≥30事件/h）。生存分析用于确定OSA和CPAP治疗对黑色素瘤复合结局的独立作用。
结果：391例患者（88.2％）在5年随访时可用于分析（平均年龄：65.1±15.2岁；男性占49％；Breslow指数：1.7±2.5毫米）。139例患者AHI<10（对照）；78例OSA患者坚持CPAP；124例和50例中度和重度OSA患者分别没有CPAP。中位随访时间为60(51-74)个月。随访期间有32例复发，53例转移和52例死亡（116例患者至少有一个主要复合结局）。在调整了年龄之后,性别,前哨淋巴结在诊断时受到影响，身体质量指数,糖尿病,Tsat90%,Breslow指数,Epworth嗜睡量表,和黑色素瘤治疗，中等(HR，2.45；95CI：1.09-5.49）和严重OSA（HR，2.96;95CI：1.36-6.42）与对照组相比，黑色素瘤的预后较差。然而,良好的CPAP依从性避免了这种额外的风险(HR，1.66；95CI：0.71-3.90）。
结论：中度至重度未经治疗的OSA是黑色素瘤预后不良的独立危险因素。与未经治疗的中度至重度OSA相比，CPAP治疗与改善的黑色素瘤预后相关。
