Obstructive sleep apnea in patients with laryngeal cancer after supracricoid or vertical partial laryngectomy

Abstract

Objective To investigate whether partial laryngectomy is a risk factor for obstructive sleep apnea (OSA) and the effect of different partial laryngectomy methods on OSA. Method A prospective study was carried out involving 40 patients who underwent supracricoid partial laryngectomy (SCPL) (24) or vertical partial laryngectomy (VPL) (16) for carcinoma of the larynx. Apnea-hypopnea index (AHI) and oxygen saturation determined by polysomnography (PSG), Epworth sleepiness scale (ESS) score, and body mass index (BMI) were evaluated in patients before surgery, on the day of tracheal tube removal and three months later. In patients who developed apnea, laryngoscopy, Muller’s test, computer tomography (CT) and dynamic sleep magnetic resonance imaging (MRI) were performed to assess the location of airway stenosis and collapse. Results The AHI ( P <0.001) increased and the lowest oxygen saturation ( P <0.001), ESS score ( P <0.001) and BMI ( P =0.017) decreased after extubation compared with before surgery. Three months after extubation, the same changes were found in AHI ( P <0.001) and the lowest oxygen saturation ( P <0.001), but the ESS score ( P <0.001) increased compared with that preoperatively. The AHI in the SCPL group was significantly higher than that in the VPL group post-operatively ( P =0.010), while the miniSpO2 in the SCPL group was lower than that of the VPL group ( P =0.022). Laryngoscopy showed that the patients with partial excision of the larynx had a narrowed retropalatal and retrolingual space post-operatively. Muller's test showed the collapse of the retropalatal and retrolingual space, and the CT scan showed that the tongue root was positioned lower in the SCPL group. Compared with the retropalatal and retrolingual space in the expiratory phase according to dynamic sleep MRI, the space in the inspiratory phase was clearly decreased. Conclusion Laryngeal function preservation surgery for laryngeal cancer results in the occurrence of OSA by altering the anatomical structure of the larynx and pharynx. OSA was more severe in patients undergoing SCPL than in patients undergoing VPL. The effect of partial laryngectomy on OSA may be related to the surgical method used.

Obstructive Sleep Apnoea in Patients Treated for Head and Neck Cancer: A Systematic Review of the Literature

“…Similarly, several factors may contribute to the increased incidence of OSA in patients treated for larynx or tongue cancer with surgery. Ouyang et al [28] studied the anatomical changes in patients with partial laryngectomy and OSA. The authors showed that after partial laryngectomy, the thyroid cartilage, which maintains open the laryngeal cavity, is replaced by soft tissue that collapses more frequently during inhalation.…”

“…Authors diagnosed OSA ranging from mild to severe in 50% of patients (Table 2). Two studies analysed the incidence of OSA in patients with head and neck cancer treated only with surgery [22,28]. These studies included only laryngeal function preservation surgery and found an OSA incidence near 85%.…”

“…Patients undergoing open partial laryngectomy II (OPHL II) had an AHI index between 17.47 and 20.6, while patients undergoing vertical partial laryngectomy (VPL) had an AHI index ranging from 9.66 to 18.2. Both studies concluded that partial laryngectomy results in OSA by altering the anatomical structures of the larynx and pharynx [22,28] (Table 3). Loth et al and Qian et al evaluated the prevalence of OSA in a population of patients with head and neck cancer, according to the treatment strategy (chemo/radiotherapy or surgery).…”

“…The other five studies analysed the incidence of OSA in patients with head and neck cancer treated either with chemo and/or radiotherapy and surgery. All of them concluded that patients treated for advanced head and neck cancer had a higher risk of OSA, ranging from 12% to 92.3%, and testing for OSA should be considered in these patients (Table 5) [20,21,25,26,28].…”

Sleep Apnoea and Cancer: Is There a Relationship?

“…In one study, patients who underwent partial laryngectomy for carcinoma of the larynx showed during laryngoscopy narrowed retro-palatal and retro-lingual space post-operatively. OSA was more severe in parallel with the residual narrow airway 55 . It is therefore concluded that after surgery/radiotherapy of this type of tumours, a sleep study should be performed routinely.…”