Date of Award


Document Type

Open Access Thesis


Health Promotion, Education and Behavior


Public Health

First Advisor

Jim Burch


Sleep disruption influences biological processes that can facilitate carcinogenesis. However, studies examining the relationship between sleep disruption and cancer risk have been inconclusive. This retrospective cohort study used de-identified data from the Veterans Administration (VA) electronic medical record to test the hypothesis that sleep disorder diagnoses among Veterans seeking care in the Southeast United States Service Network are associated with increased risk for cancer of the prostate, breast, colorectum, or total cancer (1999-2010, N=663,869). Sleep disorders were defined as patients with an in- or out-patient diagnosis as specified by the International Classification of Sleep Disorders. Cancer cases were defined as patients identified in the VA Tumor Registry during the follow-up period with a histologically confirmed primary tumor (any stage, excluding benign or in situ tumors). The relationship between a prior sleep disorder diagnosis and cancer incidence was summarized using extended Cox regression analyses with sleep disorder diagnosis as a time-varying co-variate. Sleep disorders were identified among 56,055 (8%) of eligible patients; sleep apnea (46%) and insomnia (40%) were the most common diagnoses among those with sleep disorders. There were 18,138 cancer diagnoses in the study population (42% prostate, 12% colorectal, 1% female breast, 46% other). Hazard ratios (HRs) for any cancer diagnosis ranged from 1.34 to 1.69 among patients with a diagnosed sleep disorder relative to those without sleep disorders, after adjustment for the effects of age, sex, state of residence, and marital status. There was a tendency for increased cancer risks with increasing sleep disorder duration (1-year HR: 1.04, 95% confidence interval [CI]: 1.03-1.06), (5-year HR: 1.23, 95% CI: 1.16-1.32), or (10-year HR: 1.52, 95% CI: 1.34-1.73). Results among patients with only sleep apnea, insomnia, or all other sleep disorder diagnoses were similar to those for all sleep disorders combined. Results from this study suggest that Veterans with a diagnosed sleep disorder have an increased cancer risk, and that risk increases with increasing sleep disorder duration. Optimal sleep and appropriate sleep disorder management represent modifiable risk factors that may facilitate cancer prevention.

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