Obstructive Sleep Apnea and the Risk of Cardiovascular Disease and Stroke Among Patients With Cancer: Analyses From a Multicenter Electronic Health Care Records-Based Database.
Aneni E, Pena C, Ahmed O, Otite F • Journal of the American Heart Association • 2026
OSA significantly increases the risk of CVD events in patients with cancer, especially heart failure in women, regardless of obesity status, supporting routine OSA screening in oncology populations.
Key Findings
Results
Among cancer patients, OSA was associated with a significantly higher risk of the composite cardiovascular disease outcome.
Retrospective cohort study using the TriNetX multicenter electronic health records database including adults ≥40 years diagnosed with cancer between 2012 and 2023.
Among 4,801,487 patients with cancer, 643,143 had OSA; after propensity score matching, 629,114 patients per group were analyzed.
Propensity score matching was performed on demographics and comorbidities.
The composite outcome included heart failure, atrial fibrillation/flutter, myocardial infarction, coronary revascularization, ischemic stroke, and all-cause mortality.
HR for composite CVD outcome was 1.27 (95% CI, 1.26–1.28), with 189,090 composite events recorded.
Results
OSA in cancer patients was associated with substantially increased risk of heart failure.
HR for heart failure was 1.80 (95% CI, 1.78–1.83), the largest individual component risk observed.
This represents an 80% higher relative risk of heart failure in cancer patients with OSA compared to those without OSA.
Cox proportional hazards models were used for time-to-event analyses.
The highest heart failure risk was observed in women with OSA.
Results
OSA in cancer patients was associated with significantly increased risk of atrial fibrillation or flutter.
HR for atrial fibrillation/flutter was 1.71 (95% CI, 1.69–1.74).
This represents a 71% higher relative risk compared to matched cancer patients without OSA.
Analyses were conducted using Cox proportional hazards models.
Results
OSA in cancer patients was associated with increased risk of myocardial infarction and ischemic stroke.
HR for myocardial infarction was 1.42 (95% CI, 1.39–1.45).
HR for ischemic stroke was 1.41 (95% CI, 1.38–1.44).
Both outcomes were individual components of the composite CVD endpoint.
Results
All-cause mortality was paradoxically lower in cancer patients with OSA compared to matched cancer patients without OSA.
HR for all-cause mortality was 0.84 (95% CI, 0.83–0.85), indicating a 16% lower relative risk of death in the OSA group.
The authors describe this finding as 'paradoxical.'
All-cause mortality was included as a component of the composite primary outcome.
The reason for this paradox is not explained in the abstract but may relate to surveillance bias or OSA treatment effects.
Results
The elevated cardiovascular disease risk associated with OSA in cancer patients persisted across all body mass index groups, including individuals without obesity.
Subgroup analyses were conducted by both sex and body mass index.
CVD risk from OSA was not confined to obese individuals, suggesting obesity alone does not account for the OSA-CVD relationship in cancer patients.
This finding indicates OSA is an independent cardiovascular risk factor in cancer patients regardless of weight status.
Results
Women with cancer and OSA experienced the highest risk of heart failure compared to other subgroups.
Subgroup analyses by sex revealed that the heart failure risk associated with OSA was greatest among women.
This sex-specific finding suggests women with cancer may represent a particularly high-risk group warranting attention in OSA screening efforts.
The overall cohort included adults ≥40 years diagnosed with cancer between 2012 and 2023.
What This Means
This research suggests that people with cancer who also have obstructive sleep apnea (OSA) — a condition where breathing repeatedly stops during sleep — face a meaningfully higher risk of serious heart and blood vessel problems compared to cancer patients without OSA. Using electronic health records from nearly 4.8 million cancer patients across multiple health systems, the researchers found that OSA was linked to an 80% higher risk of heart failure, a 71% higher risk of irregular heart rhythms (atrial fibrillation), and roughly 40% higher risks of heart attacks and strokes. These risks were present regardless of whether patients were overweight or obese, indicating that OSA itself — not just excess body weight — may be driving the increased cardiovascular danger.
Interestingly, the study found a paradox: despite having higher rates of serious heart events, cancer patients with OSA actually had lower all-cause mortality than those without OSA. This unexpected finding may reflect the fact that OSA patients receive more medical monitoring, or that OSA treatment provides some protective benefit, though the study did not investigate these explanations directly. The study also found that women with cancer and OSA were at especially high risk for heart failure.
This research suggests that routine screening for sleep apnea should be considered in cancer care settings, since identifying and potentially treating OSA early might reduce the burden of heart disease in people already managing a cancer diagnosis. Currently, OSA screening is not a standard part of oncology care, but these findings indicate it could be an important step in protecting the cardiovascular health of cancer patients — particularly women and those with existing heart risk factors.
Aneni E, Pena C, Ahmed O, Otite F. (2026). Obstructive Sleep Apnea and the Risk of Cardiovascular Disease and Stroke Among Patients With Cancer: Analyses From a Multicenter Electronic Health Care Records-Based Database.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.045805