Association of nocturnal hypoxemic burden and cancer incidence – a longitudinal analysis from the DIAbetes COhoRtE

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Background: Adipose tissue hypoxia has been linked to development, growth and progression of cancer, yet epidemiological evidence is sparse. Therefore, the current study investigates the relationship between nocturnal hypoxemic burden (NHB) and cancer incidence in patients with type 2 diabetes (T2D) with and without obesity. Methods: The DIACORE (DIAbetes COhoRtE) study is a prospective cohort study in patients with T2D. In the SDB (sleep-disordered breathing)-substudy, NHB was assessed as cumulative time spent below 90% oxygen saturation (T90) as well as its composition of T90 attributed to acute desaturations (T90desat) and non-specific drifts in oxygen saturation (T90non-specific). Hazard ratios (HR) for cancer incidence were calculated using multivariable Cox proportional analyses accounting for age, sex, smoking status, alcohol intake, diabetes duration and HbA1c. Results: Of 1247 patients with T2D (mean age 65 years, 42% female, mean BMI 31.0 kg/m2), 158 (13%) received a first diagnosis of cancer within the median follow-up of 6.4 years. In contrast to non-obese T2D patients (Q4vs.Q123; adjusted HR 0.523, 95% CI 0.267-1.025), in obese T2D patients (618, 50%) T90 was associated with increased cancer incidence (Q4vs.Q123; adjusted HR 1.67, 95% CI 1.04-2.67). Particularly, T90desat was not but T90non-specific was associated with cancer incidence (Q4vs.Q123; adjusted HR 1.76, 95% CI 1.09-2.84). Conclusion: NHB was associated with cancer incidence in obese T2D patients. This indicates that adipocytes could modulate the effect of NHB on cancer incidence.

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