Cancer and OSA Beyond Hypoxia Response

Abstract

At the outset, we wish to thank Dr Marvisi1 for his interest in our article. As the authors of the letter have stated, in the past few years some outstanding research groups have described other pathophysiological pathways linking OSA with cancer , some orchestrated by hypoxia2-5 and some by sleep fragmentation .2-4,6,7 Some of these pathways are related to alterations to the immune system in macrophages / monocytes , natural killer cells , lymphocytes , and other immune cells .2-7 Interesting studies and reviews of the role of microvesicles/ exosomes and the impact on the sympathetic/catecholaminergic system and other pathophysiological pathways have recently been published.2-4,8 For this reason, we decided to focus our review on clinical studies in humans that deal with the relationship between OSA and cancer incidence and mortality .9 In fact, we only outlined some basic ideas about pathophysiology in the introductory paragraph of the review , and the last paragraph was dedicated to the limitations of the clinical studies. We encourage the authors to read the excellent revisions made by Gozal et al2-4 for further information, one of which was recently published in CHEST .