Association of Sleep-Related Hypoxemia With Survival in Patients With Non-Small Cell Lung Cancer: The NEOSAS Groupe Français de Pneumo-Cancérologie Study Group.

Abstract

OSA and its hypoxia-related consequences are associated with an increased lung cancer risk. Does an association exist for OSA and sleep-related hypoxemia with increased mortality in patients with non-small cell lung cancer (NSCLC)? Patients with newly diagnosed NSCLC and Eastern Cooperative Oncology Group performance status (ECOG-PS) 0 through 2 enrolled in this multicenter study (27 study sites) were administered questionnaires and a home sleep study and were followed up for 18 months. OSA was defined as a 3% oxygen desaturation index (ODI) of ≥ 16 events/h. Cox proportional hazards models were used to evaluate the association of OSA and terciles of indices of sleep-related hypoxemia (ODI, mean oxygen saturation [Spo₂], and percentage of time with Spo₂ of ≤ 90% [T90]) with mortality. Of 1,201 patients with newly diagnosed NSCLC enrolled between February 2016 and December 2020, 1,001 patients with a valid sleep study were analyzed (71% male patients; mean [SD] age, 63.6 [9.7] years; 11% of stage I or II disease), and 383 patients (38%) had a diagnosis of OSA. Compared with patients without OSA, those with OSA showed no difference in sleep quality, quality of life, ECOG-PS, cancer stage at diagnosis, or survival. However, patients with severe sustained sleep-related hypoxemia were at higher risk of death (hazard ratio [HR], 1.35 [95% CI, 1.05-1.74] for T90 ≥ 35% vs < 4%; HR, 1.48 [95% CI, 1.16-1.98] for mean Spo₂ < 91% vs ≥ 93%) after adjustment for confounders including ECOG-PS, cancer stage, and Spo₂ with room air, and surgical treatment. Our results show that in patients with newly diagnosed NSCLC, severe nocturnal hypoxemia is associated with lower overall survival. The impact of oxygen therapy on survival deserves to be evaluated in patients with NSCLC and marked nocturnal hypoxemia. ClinicalTrials.gov; No.: NCT02648087; URL: www. gov.