{rfName}

Indexed in

License and use

Citations

33

Altmetrics

Grant support

Funding/Support This study was supported by the Fondo de Investigation Sanitaria [Grant PI16/01772] .

Analysis of institutional authors

Carrera, CristinaAuthorCastillo-Garcia, MartaAuthorAlmendros, IsaacAuthorFarre, RamonAuthor

Share

Publications
>
Article

Role of Sleep Apnea and Long-Term CPAP Treatment in the Prognosis of Patients With Melanoma A Prospective Multicenter Study of 443 Patients

Publicated to:Chest. 164 (6): 1551-1559 - 2023-12-07 164(6), DOI: 10.1016/j.chest.2023.06.012

Authors: Gomez-Olivas, Jose Daniel; Campos-Rodriguez, Francisco; Nagore, Eduardo; Martorell, Antonio; Garcia-Rio, Francisco; Cubillos, Carolina; Hernandez, Luis; Banuls, Jose; Arias, Eva; Ortiz, Pablo; Cabriada, Valentin; Gardeazabal, Juan; Montserrat, Josep Maria; Carrera, Cristina; Masa, Juan Fernando; Terreros, Javier Gomez de; Abad, Jorge; Boada, Adam; Mediano, Olga; Castillo-Garcia, Marta; Chiner, Eusebi; Landete, Pedro; Mayos, Mercedes; Fortuna, Ana; Barbe, Ferran; Sanchez-de-la-Torre, Manuel; Cano-Pumarega, Irene; Perez-Gil, Amalia; Gomez-Garcia, Teresa; Cullen, Daniela; Somoza, Maria; Formigon, Manuel; Aizpuru, Felipe; Oscullo, Grace; Garcia-Ortega, Alberto; Almendros, Isaac; Farre, Ramon; Gozal, David; Martinez-Garcia, Miguel Angel

Affiliations

Abstract

BACKGROUND: OSA has been associated with increased incidence and aggressiveness of melanoma. However, the long-term impact of OSA and CPAP treatment on the prognosis of melanoma remains unexplored. RESEARCH QUESTION: Are OSA and CPAP treatment associated independently with a poor prognosis for cutaneous melanoma? STUDY DESIGN AND METHODS: Four hundred forty-three patients with a diagnosis of cuta-neous melanoma (2012-2015) underwent a sleep study within 6 months of diagnosis. The main 5-year outcome of the study was a composite of melanoma recurrence, metastasis, or mortality. Patients were divided into four groups: baseline apnea-hypopnea index (AHI) of fewer than 10 events/h (no OSA; control group), OSA treated with CPAP and good adherence, untreated or poor CPAP adherence in moderate (AHI, 10-29 events/h), and se-vere OSA (AHI, $ 30 events/h). Survival analysis was used to determine the independent role of OSA and CPAP treatment on melanoma composite outcome. RESULTS: Three hundred ninety-one patients (88.2%) were available for analysis at 5-year follow-up (mean age, 65.1 +/- 15.2 years; 49% male; Breslow index, 1.7 +/- 2.5 mm). One hundred thirty-nine patients had AHI of fewer than 10 events/h (control group); 78 patients with OSA were adherent to CPAP; and 124 and 50 patients had moderate and severe OSA, respectively, without CPAP treatment. Median follow-up was 60 months (interquartile range, 51-74 months). During follow-up, 32 relapses, 53 metastases, and 52 deaths occurred (116 patients showed at least one of the main composite outcomes). After adjusting for age, sex, sentinel lymph nodes affected at diagnosis, BMI, diabetes, nighttime with an oxygen saturation below 90%, Breslow index, Epworth sleepiness scale scores, and melanoma treatment, mod-erate (hazard ratio [HR], 2.45; 95% CI, 1.09-5.49) and severe OSA (HR, 2.96; 95% CI, 1.36-6.42) were associated with poorer prognosis of melanoma compared with the control group. However, good adherence to CPAP avoided this excess risk (HR, 1.66; 95% CI, 0.71-3.90). INTERPRETATION: Moderate to severe untreated OSA is an independent risk factor for poor prognosis of melanoma. Treatment with CPAP is associated with improved melanoma outcomes compared with untreated moderate to severe OSA. CHEST 2023; 164(6):1551-1559

Keywords

aggressivenesscancercpapintermittent hypoxiamelanomamortalitysleep apneaAdultAgeAgedAged, 80 and overAggressivenessApnea hypopnea indexArticleBody massCancerCancer prognosisCancer recurrenceClinical outcomeClinical trialComplicationContinuous positive airway pressureControlled studyCpapCross-sectional studyCutaneous melanomaDiabetes mellitusDisease severityEpidemiologyEpworth sleepiness scaleFemaleFollow upHumanHumansLongitudinal studyLung-cancerMajor clinical studyMaleMelanomaMiddle agedMortalityMortality rateMulticenter studyNeoplasm recurrence, localObstructive sleep apneaOxygen saturationPatient compliancePrognosisProspective studiesProspective studyRisk factorSentinel lymph node metastasisSexSkin neoplasmsSkin tumorSleep apneaSleep apnea syndromesSleep apnea, obstructiveSleep studySurvival analysisTumor recurrenceVery elderly

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Chest due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 7/101, thus managing to position itself as a Q1 (Primer Cuartil), in the category Respiratory System. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.4. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 2.69 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 14.55 (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-06, the following number of citations:

  • WoS: 12
  • Scopus: 14
  • Europe PMC: 7
  • OpenCitations: 11

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-06:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 8.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 11 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 21.55.
  • The number of mentions on the social network X (formerly Twitter): 12 (Altmetric).

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: United States of America.