• Jose Daniel Gómez-Olivas, Francisco Campos-Rodriguez, Eduardo Nagore, Antonio Martorell, Francisco García-Rio, Carolina Cubillos, Luis Hernandez, Jose Bañuls, Eva Arias, Pablo Ortiz, Valentin Cabriada, Juan Gardeazabal, Josep Maria Montserrat, Cristina Carrera, Juan Fernando Masa, Javier Gomez de Terreros, Jorge Abad, Adam Boada, Olga Mediano, Marta Castillo-Garcia, Eusebi Chiner, Pedro Landete, Mercedes Mayos, Ana Fortuna, Ferrán Barbé, Manuel Sanchez-de-la-Torre, Irene Cano-Pumarega, Amalia Perez-Gil, Teresa Gomez-Garcia, Daniela Cullen, Maria Somoza, Manuel Formigon, Felipe Aizpuru, Grace Oscullo, Alberto Garcia-Ortega, Isaac Almendros, Ramón Farré, David Gozal, and Miguel Angel Martinez-Garcia.
• Respiratory Department, Hospital Universitario y Politecnico la Fe, Hospital de Manises, Valencia, Spain.
• Chest. 2023 Dec 1; 164 (6): 155115591551-1559.

BackgroundOSA 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.Research QuestionAre OSA and CPAP treatment associated independently with a poor prognosis for cutaneous melanoma?Study Design And MethodsFour 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.ResultsThree 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).InterpretationModerate 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.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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