The severity of sleep-disordered breathing (SDB) has been independently associated with the increased aggressiveness of cutaneous melanoma (CM), according to the results of a cross-sectional study of consecutive patients diagnosed with CM, conducted at 29 Spanish hospitals and published in CHEST.

Investigators sought to evaluate the potential associations between SDB severity and markers of CM aggressiveness. A total of 443 patients with a diagnosis of CM were enrolled in the study. The mean age of the participants was 55.9±15.3 years, and 50.6% were men. All patients underwent a sleep study within 6 months of CM diagnosis.

Patient demographics were collected, as well as melanoma features and polygraphic parameters, which included apnea-hypopnea index (AHI) and indices of both continuous and intermittent nighttime oxyhemoglobin desaturation (ie, desaturation index at 4% [DI4%]). Independent relationships between SDB and various objective markers of melanoma aggressiveness were explored, including Breslow index, presence of regression, presence of ulceration, stage of disease severity, mitotic index, damage to the sentinel lymph node, and spread of melanoma.

Those individuals in the upper tertiles of AHI (ie, AHI >15.6 events/hour) or DI4% (ie, >9.3 desaturations/hour) exhibited an approximately 2-fold greater probability of presenting with a melanoma with a greater aggressiveness (ie, Breslow >1 mm) compared with the reference group. To be more precise, those in the upper tertile of AHI were 1.96 times more likely (95% CI, 1.14-3.36; P =.014), and those in the upper tertile of DI4% were 1.95 times more likely (95% CI, 1.15-3.30; P =.013), to present with aggressive melanoma than were those in the lowest tertiles of these sleep attributes, after adjustments for sex, age, body mass index, and location of the tumor.

This association was particularly prominent among those individuals <56 years of age with a Breslow index >2 mm. The presence of additional markers of melanoma aggressiveness was also linked to higher AHI and DI4% values.

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The investigators concluded that the severity of SDB is independently and significantly associated with greater aggressiveness of CM, especially in younger patients. Future prospective studies are warranted to confirm whether the presence and treatment of SDB, and its evolution over time, are also linked to poor melanoma outcomes, including death, as well as to explore the pathophysiologic mechanisms underlying this association.


Martinez-Garcia MA, Campos-Rodriguez F, Nagore E, et al. Sleep-disordered breathing is independently associated with increased aggressiveness of cutaneous melanoma. a multicentre observational study in 443 patients [published online July 27, 2018]. CHEST. doi:10.1016/j.chest.2018.07.015