Obstructive sleep apnea in the irradiated head and neck cancer patient

To assess the prevalence of obstructive sleep apnea (OSA) in head and neck cancer (HNSCC) patients treated with radiation therapy.

Prospective case series without comparison group.

Patients who underwent radiation therapy for oropharyngeal or laryngeal squamous cell carcinoma completed a 3-night home sleep test (HST), Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, and University of Washington Quality of Life questionnaire. Exclusion criteria included oncologic surgical procedures, active disease, history of tracheotomy, history of OSA, or completion of radiation therapy within the last 3 months.

Sixteen HNSCC patients completed the HST, with 50% (8) demonstrating objective evidence of OSA ranging from mild to severe (range 5.6-38.8, median 13.9). Median age was 61.6 years, with a median body mass index (BMI) of 29.8, and 13 of the subjects were male. There were no differences in age, BMI, median radiation dose, tumor primary site or stage, human papilloma virus status, or comorbidity status between the OSA and non-OSA groups. Self-reported questionnaire scores were no different between the two groups. OSA patients had a nonsignificant shorter time interval between the completion of radiation and the HST date (1.8 vs. 3.4 years, P = 0.065) and higher rate of gastrostomy tube placement during radiation (62.5% vs. 12.5%, P = 0.059).

The results of this preliminary study suggest that the prevalence of OSA is increased in the head and neck irradiated patient when compared to the general population. Self-report of sleep symptoms alone may be unreliable to determine risk of OSA in the HNSCC population.

4. Laryngoscope, 127:2673-2677, 2017.