Editorial
Sleep and Cancer
Sueño y cáncer
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Marín" "autores" => array:1 [ 0 => array:4 [ "nombre" => "José M." "apellidos" => "Marín" "email" => array:1 [ 0 => "jmmarint@unizar.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CIBER Enfermedades Respiratorias (CIBERES), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sueño y cáncer" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">The sleep of a laborer is sweet, whether they eat little or much, but as for the rich, their abundance permits them no sleep.</span></p><span class="elsevierStyleSource">Ecclesiastes 5:12</span></span></p><p id="par0010" class="elsevierStylePara elsevierViewall">The quantity and quality of sleep has always been a concern for mankind, and it is known to be essential for sustaining life in general and human life in particular. All patients with acute and chronic disease suffer altered sleep patterns. Cancer patients, in particular, suffer fatigue and difficulties falling or staying asleep. This editorial does not address this topic, but instead discusses the influence of primary sleep-disordered breathing on the development of cancer, and the role of the respiratory medicine specialist now and in the future.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The circadian rhythm is an essential biological function in all living beings, and determines physiological changes and behavior over a 24-h period. In mammals, the circadian “pacemaker” is located in the suprachiasmatic nucleus (SCN) in the hypothalamus. Circadian rhythms are genetically determined, and preliminary studies have reported the presence of certain genetic polymorphisms that might determine disorders in the sleep–wake pattern. Epigenetic modifications in key genes for circadian regulation have been reported in shift workers and individuals exposed to high levels of light at night, modifications that simultaneously alter the transcription of regulatory genes related with susceptibility to cancer.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Epidemiological studies performed in these workers have found an association between the risk of cancer, particularly breast cancer,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and shift work. The intermediary mechanisms that might explain the relationship between shift work and the risk of cancer are unknown. Melatonin is known to have anti-oncogenic effects, and <span class="elsevierStyleItalic">in vitro</span> studies have shown it to increase expression of the PER2 gene which, among other things, reduces the production of β-catenine. This protein increases cyclin-D levels, activating the proliferation of neoplastic cells. Various melatonin receptors affecting tumor physiology have been described in breast cancer tumor cells. In both male and female shift workers, melatonin levels at night and in 24-h urine are reduced and fluctuate much less than in day-time workers.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> This finding would support the laboratory studies mentioned above, but to date no causal relationship has been identified between melatonin and the risk of cancer, and no interventional trials been performed with melatonin in animals or in humans.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Sleep duration, whether too short or too long, and its relationship with the risk of cancer, has been evaluated in some population studies, with inconsistent results. Instead of studying real “sleep time”, which is difficult to establish since it is based on reported questionnaires, it is easier to study sleep fragmentation (SF) and its relationship with the risk of cancer. In animal models in which SF was induced while preserving sleep time and eliminating the potential effect of intermittent hypoxia (IH), the degree of SF was determined to be associated with greater proliferation rates and tumor development.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> In another animal study, Almendros et al. evaluated the effect of IH, but this time the effect of SF was eliminated. They showed clearly that IH was associated with a faster melanoma growth rate and an early and more intense development of distant metastasis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> To date, no experimental studies have been conducted to evaluate the relative importance of these 2 intermediate mechanisms (SF and IH) in the same animal model. What intermediate mechanisms might favor oncogenesis induced by SF and IH? Recent experiments in rat models have shown that IH did not induce direct dysplastic changes, but instead changed the polarity of the macrophages, transforming them into a less immunocompetent phenotype (M2) that would allow greater tumor proliferation.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> M2 macrophages also were elevated in animal models of SF, in this case increasing toll-like receptor 4 expression.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> It seems, then, that the 2 main components of obstructive sleep apnea (OSA), SF and IH, cause changes in innate immunity.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Confirmation of these phenomena in humans would suggest that anticancer surveillance and neoplastic growth control phenomena are less effective in patients with OSA. The Spanish Sleep Group demonstrated almost simultaneously with the Wisconsin group that untreated OSA patients had a greater incidence of cancer,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> providing epidemiological data to support the results of the <span class="elsevierStyleItalic">in vitro</span> research. However, a Canadian population study was unable to confirm this association.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Interested readers can consult the excellent review by Martinez-Garcia on this subject that appeared recently in Archivos de Bronconeumología.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">What are the clinical implications of these studies on the relationship between sleep and cancer? In my opinion, no robust studies establishing the relationship between the amount and the quality of sleep and cancer have yet been published. For now, we must insist on the need for good sleep hygiene and avoid treatments that alter natural sleep. As respiratory medicine specialists, we are in the front line of treating patients with OSA. There is still no evidence to establish a causal relationship between OSA and cancer, so there is no need to actively investigate for cancer the first time we see a patient with OSA, nor do we need to change our current therapeutic practice. However, the available information obliges us to be more alert to the potential risk of cancer as a comorbidity in OSA patients and to monitor them regularly, but without causing alarm.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Marín JM. Sueño y cáncer. Arch Bronconeumol. 2017;53:302–303.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Shift work and cancer risk: potential mechanistic roles of circadian disruption, light at night, and sleep deprivation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.L. Haus" 1 => "M.H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 44 | 20 | 64 |
| 2024 September | 48 | 19 | 67 |
| 2024 August | 60 | 39 | 99 |
| 2024 July | 39 | 20 | 59 |
| 2024 June | 55 | 24 | 79 |
| 2024 May | 76 | 28 | 104 |
| 2024 April | 52 | 26 | 78 |
| 2024 March | 42 | 21 | 63 |
| 2024 February | 55 | 22 | 77 |
| 2023 March | 9 | 3 | 12 |
| 2023 February | 53 | 24 | 77 |
| 2023 January | 30 | 44 | 74 |
| 2022 December | 45 | 34 | 79 |
| 2022 November | 36 | 27 | 63 |
| 2022 October | 61 | 43 | 104 |
| 2022 September | 34 | 33 | 67 |
| 2022 August | 32 | 52 | 84 |
| 2022 July | 38 | 53 | 91 |
| 2022 June | 22 | 39 | 61 |
| 2022 May | 27 | 37 | 64 |
| 2022 April | 37 | 33 | 70 |
| 2022 March | 32 | 40 | 72 |
| 2022 February | 35 | 32 | 67 |
| 2022 January | 36 | 43 | 79 |
| 2021 December | 23 | 40 | 63 |
| 2021 November | 35 | 49 | 84 |
| 2021 October | 53 | 53 | 106 |
| 2021 September | 41 | 48 | 89 |
| 2021 August | 32 | 60 | 92 |
| 2021 July | 27 | 33 | 60 |
| 2021 June | 55 | 69 | 124 |
| 2021 May | 37 | 74 | 111 |
| 2021 April | 107 | 67 | 174 |
| 2021 March | 66 | 35 | 101 |
| 2021 February | 53 | 32 | 85 |
| 2021 January | 59 | 34 | 93 |
| 2020 December | 54 | 82 | 136 |
| 2020 November | 55 | 55 | 110 |
| 2020 October | 36 | 29 | 65 |
| 2020 September | 39 | 25 | 64 |
| 2020 August | 36 | 29 | 65 |
| 2020 July | 99 | 51 | 150 |
| 2020 June | 19 | 21 | 40 |
| 2020 May | 28 | 14 | 42 |
| 2020 April | 33 | 14 | 47 |
| 2020 March | 35 | 16 | 51 |
| 2020 February | 75 | 25 | 100 |
| 2020 January | 33 | 18 | 51 |
| 2019 December | 51 | 15 | 66 |
| 2019 November | 42 | 23 | 65 |
| 2019 October | 29 | 14 | 43 |
| 2019 September | 26 | 12 | 38 |
| 2019 August | 27 | 17 | 44 |
| 2019 July | 30 | 34 | 64 |
| 2019 June | 14 | 11 | 25 |
| 2019 May | 27 | 24 | 51 |
| 2019 April | 34 | 29 | 63 |
| 2019 March | 28 | 17 | 45 |
| 2019 February | 24 | 25 | 49 |
| 2019 January | 28 | 25 | 53 |
| 2018 December | 42 | 26 | 68 |
| 2018 November | 44 | 17 | 61 |
| 2018 October | 79 | 21 | 100 |
| 2018 September | 37 | 11 | 48 |
| 2018 May | 22 | 1 | 23 |
| 2018 April | 39 | 5 | 44 |
| 2018 March | 58 | 3 | 61 |
| 2018 February | 57 | 9 | 66 |
| 2018 January | 120 | 4 | 124 |
| 2017 December | 42 | 10 | 52 |
| 2017 November | 38 | 13 | 51 |
| 2017 October | 26 | 12 | 38 |
| 2017 September | 31 | 14 | 45 |
| 2017 August | 0 | 1 | 1 |
| 2017 April | 0 | 2 | 2 |
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