Head-and-neck paragangliomas are associated with sleep-related complaints, especially in the presence of carotid body tumors

Abstract

ObjectivesThe carotid body functions as a chemoreceptor. We hypothesized that head-and-neck paragangliomas (HNP) may disturb the function of these peripheral chemoreceptors and play a role in sleep-disordered breathing.DesignThis is a case–control study.SettingThis study was conducted in a tertiary referral center.Participants and main outcome measuresWe assessed fatigue, sleep, and exercise capacity in 74 HNP patients using three questionnaires (Epworth Sleepiness Scale, St. George Respiratory Questionnaire, and a standard clinical sleep assessment questionnaire). Outcomes were compared to those of age- and sex-matched controls.Results and conclusionsActivity, disturbance of psychosocial function, and total score were worse compared to controls (15.4 ± 18.5 vs. 7.2 ± 9.9, P = 0.007; 5.3 ± 10.5 vs. 1.2 ± 2.6, P = 0.008; and 10.4 ± 12.9 vs. 5.0 ± 4.8, P = 0.006, respectively). Patients reported more daytime fatigue, concentration difficulties, and depression (51% vs. 24%, P = 0.006; 31% vs. 10%, P = 0.010; and 19% vs. 2%, P = 0.012). Waking up was reported to be less refreshing in HNP patients (53% vs. 73%, P = 0.038). Dysphonia was a predictor of symptoms, activity, disturbance of psychosocial function, and total scores. Remarkably, the presence of a carotid body tumor was an independent predictor of increased daytime sleepiness (β = 0.287, P = 0.029). In conclusion, patients with HNP have remarkable sleep-related complaints. Especially the presence of carotid body tumors appears to be associated with increased daytime somnolence.

“Unveiling Unique Pathologies in Obstructive Sleep Apnea: Two Intriguing Case Reports”

“…Glomus tumors are rare, and their association with OSA is not well-documented in the literature. 12 Further research is needed to understand the underlying mechanisms better and establish a more precise correlation between glomus tumors and OSA. 13 Some studies show that these tumors do produce more symptoms of OSA, especially when they are bilateral and related to airway obstruction.…”

Two stage, hybrid endovascular and open surgical approach to treat difficult carotid body tumors

“…5 It is important to emphasize that this tumor will never stop growing, and the resulting increase in volume produces marked signs of compression. 6,7 Finally, this type of tumor, even though it is histologically benign, could have the capacity to metastasize, although it will always be difficult to know if it is metastatic activity or multifocal disease. 8 Depending on the size, extent and level of invasion into neighboring structures, resection of the tumor can lead to serious complications, 5 to the degree that if the tumor is over 5 cm, mortality rates can range as high as 1%-3% post-surgery 9 and there is a clear correlation between tumor size and morbidity of the cranial nerves, as well as cerebrovascular damage: the larger the carotid body tumor, the greater the morbidity of these structures.…”

“…Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1‐cm decrease in the distance to the skull base results in 1.8 times increase in >250 ml of blood loss and 1.5 times increased risk of cranial nerve injury 5 . It is important to emphasize that this tumor will never stop growing, and the resulting increase in volume produces marked signs of compression 6,7 . Finally, this type of tumor, even though it is histologically benign, could have the capacity to metastasize, although it will always be difficult to know if it is metastatic activity or multifocal disease 8 …”

Psychosocial distress and the preferred method of delivery of mind–body interventions among patients with head-and-neck cancer

“… 20 HNC patients with sleep disturbances further reported increased daytime fatigue, concentration difficulties, and symptoms of depression. 21 One year after the completion of treatment, sleep disturbances predicted survival among HNC patients. 22 HNC patients are at increased risk for sleep disturbances as a result of high rates of pain, depression, nicotine and alcohol use, obstructive sleep apnea, surgical alterations, and xerostomia.…”