Sleep Apnea Increases Risk of Cancer

Obstructive sleep apnea has been getting accused of causing all sorts of medical problems including hypertension, stroke, heart disease, heart attacks, peripheral vascular disease, etc. We can also add cancer now.

According to Australian researchers, moderate to severe sleep apnea increases the risk of cancer by 2.5 times and death from cancer by 3.4 times. They also reported that sleep apnea increases risk of death (any cause) by 4.2x and stroke by 3.7x.

This conclusion was reached evaluating 397 subjects with obstructive sleep apnea with 20 years follow-up. Of course, further study is needed to confirm these findings.

If sleep apnea is suspected, the first step is to get a sleep study. Surgical options can also be considered which may encompass UPPP, base of tongue reduction, etc.

Source:
Sleep Apnea and 20-Year Follow-Up for All-Cause Mortality, Stroke, and Cancer Incidence and Mortality in the Busselton Health Study Cohort. Journal of Clinical Sleep Medicine 2014;10(4):355-362.

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Mouthwash May Increase Risk of Oral Cancer

Drinking alcoholic beverages is known to increase risk of oral cancer. It is now suspected that using mouthwash containing alcohol (i.e., original Listerine) may also increase risk for oral cancer.

When it comes to drinking alcoholic beverages like beer, individuals who consume 50 or more grams of alcohol per day (approximately 3.5 or more drinks per day) have at least a two to three times greater risk of developing oral cancer than nondrinkers. Moreover, the risk of cancer is substantially even higher among individuals who consume this amount of alcohol and also use tobacco.

What people may not realize is that some popular over-the-counter mouthwashes ALSO contain alcohol... quite a bit of it with some containing up to 27% of volume. Alcohol is added to provide flavor and "bite." For example, Listerine contains alcohol concentrations of 21.6% in the flavored product and 26.9% in the original gold Listerine Antiseptic.

Whether alcohol is introduced into the mouth via beer or mouthwash, carcinogenic risk is present.

According to one preliminary research, the risk of developing oral cancer from mouthwash containing alcohol is almost 5 times higher than those who do not. Subsequent small studies have not supported this cancer risk, but in 2014, research performed on 3,956 patients did find an independent increased risk of cancer if alcohol-containing mouthwash was used 3 or more times a day.

It is hypothesized that alcohol content in mouthwashes allows for carcinogens to penetrate into the mouth lining increasing cancer risk.

Given the possible increased risk of oral cancer, it may be worthwhile to avoid mouthwashes containing alcohol, especially given there are plenty of alcohol-free mouthwashes commercially sold.




References:
The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes. Aust Dent J. 2008 Dec;53(4):302-5. doi: 10.1111/j.1834-7819.2008.00070.x.

Carcinogenicity of alcoholic beverages Exit Disclaimer. Lancet Oncology 2007;8(4):292-293.

Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiology, Biomarkers & Prevention 2009;18(2):541-550.

Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: The ARCAGE study. Oral Oncol. 2014 Mar 26. pii: S1368-8375(14)00065-7. doi: 10.1016/j.oraloncology.2014.03.001

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Snoring is Bad for the Heart? Not so fast...

This past week, media has both aired and published a story regarding new research that suggests snoring WITHOUT obstructive sleep apnea may lead to potential increased risk of heart disease as well as stroke.

Apparently, researchers in Michigan examined the data of 913 patients between the ages of 18 and 50 who had undergone a sleep study between 2006 and 2012. None had been diagnosed with sleep apnea, but did have significant snoring. These patients underwent an ultrasound that measured the thickness of the carotid artery inner lining. The thicker the inner lining of the carotid artery, the higher the risk for carotid artery disease and stroke.

The researchers found that in their patient population, the carotid arteries were thicker in snorers than in non-snorers. In fact, these abnormal changes were comparable to smokers, diabetics, and patients with hypertension.

Unfortunately, their findings have not yet been published (though submitted to the journal Laryngoscope), but was presented at the Combined Sections Meeting of the Triological Society in Scottsdale, Arizona held between January 24-26, 2013.

However, this is not the first study to show a link between snoring and heart disease. Hungarian researchers in 2008 reported that loud snorers were at significantly higher risk for stroke and heart disease in their study population of 12,642 subjects.

Contradictory Research: Snoring is NOT Bad for the Heart

Now, before every snorer goes into a panic regarding the fact that they snore, even if there are no problems with obstructive sleep apnea confirmed on sleep study, consider this...

Australian researchers published findings in 2012 that snoring did NOT increase risk for heart disease and mortality regardless of whether the patient suffered from sleep apnea or not. Their population study group consisted of 380 subjects.

What's Going On?

Admittedly, the burden of epidemiological evidence does suggest a link between snoring alone and potential increased risks for stroke and heart disease. But the very factors that predispose to snoring are also associated with other diseases that confound a conclusive relationship. Such other confounding factors include obesity, hypertension, diet, age, smoking, and alcohol consumption. When ignoring snoring-related health issues, there are numerous other confounding factors including periodontal disease, personality, stress, sedentary lifestyle, etc.

A study I would like to see to help clear the confusion regarding the risk of snoring would be to examine a large population of subjects who snore, but who are all skinny, non-smokers, non-alcohol drinkers, not diabetic, do not have high blood pressure, eat a balanced healthy diet, do not have a type A personality, good teeth, exercise daily, and lead a relatively stress-free life.

Any takers???

Assuming Snoring DOES Lead to Elevated Risk

The simplistic reason this may occur is due to acoustic and vibrational trauma that gets transmitted from the airway to the carotid arteries located nearby in the neck. Such snore-induced vibrational trauma leads to micro-injury to the inner lining of the carotid artery leading to thickening.

With thickening, the carotid arteries in essence become more narrow leading to increased risk of stroke.

Such vascular injury can also lead to increased levels of catecholamines that can lead to similar changes elsewhere in the body including the heart.

Of course, there are more complex variables at play which requires more complex answers, but that's beyond the scope of this blog.

Treatment

Snoring is unfortunately a complex problem to fix and does require some testing to fully evaluate and treat successfully. Such tests include fiberoptic laryngoscopy, sleep study and sedated endoscopy.


Source:
Snoring May Be as Bad as Smoking for Your Heart. Medical Daily 1/24/13

References:
Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey. Sleep 2008 Mar;31(3):411-6.

Snoring Is Not Associated With All-Cause Mortality, Incident Cardiovascular Disease, or Stroke in the Busselton Health Study. Sleep. 2012 Sep 1;35(9):1235-40. doi: 10.5665/sleep.2076.

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