Does CPAP increase or protect against cancer risk in OSA: a systematic review and meta-analysis.

BACKGROUND

Obstructive sleep apnea (OSA) is a prevalent sleep disorder associated with intermittent hypoxia, sleep fragmentation, and systemic inflammation, all of which may influence cancer development. Continuous positive airway pressure (CPAP) therapy is the primary treatment for OSA, yet its impact on cancer risk remains uncertain. We conducted a systematic review and meta-analysis to evaluate the association between CPAP therapy and the incidence of newly diagnosed cancer in patients with OSA.

METHODS

From inception to March 2025, a comprehensive literature search of MEDLINE, EMBASE, Cochrane databases, and reference lists was conducted. Observational studies assessing the risk of new cancer diagnoses in OSA patients treated with CPAP compared to non-CPAP users were included. Data extraction and quality assessment followed PRISMA guidelines, and meta-analysis was performed using a random-effects model.

RESULTS

Three cohort studies from France, Spain, and Canada, including 72,498 participants, met the inclusion criteria. CPAP compliance varied, defined as > 4 h/night in two studies, while one study lacked specific usage criteria. Cancer diagnoses were ascertained via national registries, hospital databases, or electronic medical records. Meta-analysis revealed a pooled hazard ratio (HR) of 0.81 (95% CI: 0.60-1.09), suggesting a potential reduction in cancer risk among CPAP users. Sensitivity analysis reduced heterogeneity (I² = 0%) and revised the HR to 0.93 (95% CI: 0.81-1.08).

CONCLUSIONS

CPAP therapy does not appear to increase cancer risk in OSA patients, but the evidence is limited and inconclusive. Further research, including randomized controlled trials, is needed to confirm these observations and explore underlying mechanisms.