Scoping review of head and neck neoplasms presenting with obstructive sleep apnoea: the importance of flexible nasendoscopy

Abstract

Background Obstructive sleep apnoea (OSA) can be caused by neoplasms involving the upper aerodigestive tract. Currently, many of these patients have this diagnosis missed, as most adults diagnosed with OSA do not undergo adequate head and neck examination including flexible nasendoscopy. We performed a review of the literature to shed light on this phenomenon and outline the pathologies and issues surrounding this sub‐population of patients diagnosed with OSA. Methods A scoping review of the literature was conducted on head and neck neoplasms presenting with OSA. Data were extracted on demographics, clinical presentation, histopathology, treatment and patient outcomes. Results Sixty‐seven articles were included, describing 79 patients. Mean age was 45.8 years, and 77.2% were male. Symptoms of OSA were present for an average of 29.2 months before a diagnosis of causative neoplasm was made. Forty‐two different benign and malignant histopathological entities were reported. At diagnosis, the causative pathology of 100% of patients was visible on head and neck examination including flexible nasendoscopy, while only 53.2% were visible on trans‐oral examination. One‐third of patients had commenced inappropriate treatment for OSA, including three who had undergone sleep surgical procedures. The majority of patients were treated with surgery alone (72.2%). Conclusion Although rare, neoplasms of the upper aerodigestive tract should be considered as a cause of OSA, especially in patients experiencing other symptoms in addition to the typical symptoms of OSA. They should particularly be considered in patients with comparatively lower body mass index or those with worsening OSA without an apparent cause identified.

Covid-19 and Obstructive Sleep Apnea: The Theatricals and Quality-of-Life Impact

“…Table 2 OSA due to abscesses formed the bulk of our sample (n = 59,60.82%) [53] followed by HNAL (n = 33,34.02%) [54][55][56][57]. Other unique pathologies mimicking OSA in our series presented as large crops over a short duration.…”

Obstructive Sleep Apnea in Patients with Head and Neck Cancer—More than Just a Comorbidity?

“…Head and neck cancer should be considered in patients experiencing symptoms besides typical symptoms of OSA and particularly in patients with lower BMI. A scoping review of Moore and colleagues summarized 79 cases of OSA being the leading symptom of head and neck cancer [30]. The authors suggested flexible nasal endoscopy as a potential tool for OSA evaluation in selected individuals since the causative malignant pathology was visible in all examined patients [30].…”

Comorbidities and Laryngeal Cancer in Patients with Obstructive Sleep Apnea: A Review

“…This condition represents a major risk for triggering diseases such as hypertension, ischemic heart disease, diabetes, arrhythmias, or mental illnesses. As a result, it affects the quality of life in a direct way [1].…”

“…Investigation methods and local examination, such as nasopharyngoscopy, oropharyngoscopy, and laryngoscopy, allow for the evaluation of the upper airway, the oral cavity, the pharynx, the larynx, the salivary glands, and the thyroid region [1].…”

“…Tumors located at these levels or involving the para-and retropharyngeal spaces cause a narrowing of the respiratory space, sometimes up to its complete obstruction, with the onset of OSA. Tumor formations can be diagnosed during a clinical examination, but often, they cannot be visualized because they infiltrate the deeper tissues, and the overlying mucosa remains unmodified [1].…”