Obstructive Sleep Apnea and Short- and Long-Term Outcomes After Pancreatic Cancer Resection

Obstructive sleep apnea (OSA) has been associated with higher incidence of multiple cancers, including pancreatic adenocarcinoma (PDAC) and worse pathologic prognostic features in resected PDAC. However, its impact on clinical outcomes following surgical resection remains unknown.

Adult patients with PDAC who underwent surgical resection and systemic chemotherapy from 2015 to 2019 were identified using the Surveillance, Epidemiology, and End Results-Medicare database. OSA was identified within the 12 mo preceding PDAC diagnosis. Primary outcomes included overall survival, cancer-specific survival, and 90-d postoperative outcomes following propensity score-matched analysis.

A total of 4005 patients were included for analysis, with a mean age of 72.7 years (interquartile range: 68-77). The majority of patients were White (90%, n = 3596), with a balanced sex distribution. OSA prevalence was 10.8% (n = 431). After covariate adjustment, OSA was associated with high odds of 90-d readmission (49% versus 40%; odds ratio = 1.28, 95% confidence interval [CI]: 1.01-1.62, P = 0.038) and postoperative infection, including surgical site infection and intraabdominal abscess (7.7% versus 4.3%; odds ratio 1.85, 95% CI 1.13-3.00; P = 0.013). Overall survival (2.33 versus 2.25 y; hazard ratio = 0.97, 95% CI: 0.83-1.14; P = 0.71) and cancer-specific survival (2.67 versus 2.50 y; hazard ratio = 0.99, 95% CI: 0.83-1.17, P = 0.88) were comparable between groups.

OSA was not independently associated with survival outcomes following PDAC resection. The observed associations with readmission and postoperative infection warrant cautious interpretation given modest effect sizes.