Severe obstructive sleep apnea after concurrent chemoradiotherapy for laryngeal and hypopharyngeal cancer managed by CPAP

Inoshita, Ayako; Matsumoto, Fumihiko; Ohba, Satoru; Sata, Naoko; Matsuoka, Rina; Suzuki, Yo; S, Itó; Koiwai, Hiroko; Shiroshita, Nanako; Kasai, Takatoshi; Ikeda, Katsuhisa

doi:10.1016/j.anl.2021.05.003

Cited by 6 publications

(6 citation statements)

References 13 publications

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“…Considering the results of this, the reason that 85.7% of residual OSA in post-treatment despite having a wider pharyngeal morphology is considered by dry mouth, dysphagia, and laryngeal dysfunction with irradiation (12,39,40). Consequently, laryngeal function might have decreased, and residual OSA was revealed after treatment.…”

Section: Discussionmentioning

confidence: 89%

“…RT, such as CRT, for advanced carcinoma of the pharynx and larynx can reduce the need for surgical procedures, and is becoming a standard therapy to enable larynx preservation in patients with HNC (9,36). However, the disadvantages of irradiation, such as dry mouth, mucositis with sores, and difficulty in swallowing should be considered (12). Increased BMI and neck circumference have been reported to be important risk factors for OSA in the general population, whereas sleep apnea and hypoxia tend to improve after weight loss (37,38).…”

Section: Discussionmentioning

confidence: 99%

“…For post-treatment tests, only those who gave consent and had a sleep test during hospitalization were included. Based on our past experience, post-treatment tests were performed 2 months after starting the treatment (12). The results of the sleep test, including apnea-hypopnea index (AHI), lowest oxygen saturation (SO 2 ), the time of SO 2 less than 90% during sleep (SO 2 <90%), and oxygen desaturation index (ODI), were evaluated.…”

Section: Sleep Studymentioning

confidence: 99%

“…Therefore, definitive radiation therapy (RT) alone, induction chemotherapy, and chemoradiotherapy (CRT) are considered necessary for organ preservation, and are mainstays of locally advanced HNC, but these combined radiation treatments can have serious side effects (9)(10)(11). We previously reported a case of severe OSA diagnosed and treated with continuous positive airway pressure (CPAP) after concurrent chemoradiotherapy (CRT) for laryngeal and hypopharyngeal cancer (12). Some authors have previously reported a relatively high prevalence of OSA in patients following RT for HNC, but little is known about the impact of such treatment on sleep disorders and their underlying mechanisms (13,14).…”

Section: Introductionmentioning

confidence: 99%

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Impact of radiotherapy for head and neck cancer on obstructive sleep apnea: a prospective study

Inoshita¹,

Sata²,

Ohba³

et al. 2022

Ann Palliat Med

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Background: In recent years, a relatively high prevalence of obstructive sleep apnea (OSA) in patients following radiotherapy (RT) for head and neck cancer (HNC) has been reported; however, little is known regarding the impact of RT on sleep disorders and the underlying mechanisms. This aim of this study was to elucidate the pathogenesis of OSA by comparing the clinical and sleep test parameters and magnetic resonance imaging (MRI) findings before and after HNC treatment with radiation.Methods: This prospective study included patients scheduled for RT with or without chemotherapy or bioradiotherapy for HNC. Patients diagnosed with HNC between May 2017 and August 2020 were consecutively recruited. The results of the sleep tests were analyzed both before and after treatment. The clinical characteristics of the patients and cephalometric and MRI parameters were also measured.Results: First, a total of 32 patients (64.8±11.8 years old; BMI, 22.7±3.6 kg/m 2 ) underwent pre-treatment sleep tests. The prevalence of OSA [apnea hypopnea index (AHI) ≥5] in these patients was 81.3% (26 patients) before treatment, and the mean AHI was 20.8±19.0 events/hr. Next, 21 patients performed a sleep test both before and after treatment. Regarding subjective symptoms, there were no significant differences in the Epworth Sleepiness Scale (ESS) (P=0.142) or Pittsburgh Sleep Quality Index (PSQI) (P=0.935) after treatment; however, the BMI and neck circumference significantly decreased after treatment (P<0.0001 and P=0.0001, respectively). The incidence of OSA in these patients was 81.0% (17 patients) before treatment and 85.7% (19 patients) after treatment (P=1.0). Overall, the AHI was not significantly different, changing only from 14.5 to 14.9 after treatment (P=0.147). The MRI parameters showed that the retroglossal pharyngeal area increased significantly after treatment (P=0.007).Conclusions: This study found that the prevalence of OSA before and after RT for HNC was higher than that in the normal population, despite a significant decrease in BMI and increase in the retroglossal pharyngeal area after treatment. We suggest that physicians who manage patients with HNC should consider the occurrence of OSA before and after treatment.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Sleep Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of radiotherapy for head and neck cancer on obstructive sleep apnea: a prospective study

Inoshita¹,

Sata²,

Ohba³

et al. 2022

Ann Palliat Med

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“…Epiglottic collapse caused by CPAP indicates reduced tolerability of this treatment. Therefore, alternative treatment options for patients with tumors may include upper-airway surgery or tracheostomy [28]. Multiple studies indicate a decline in the quality of life of patients with head and neck tumors, especially in terms of voice quality both pre-and post-therapy over a 24-month period.…”

Section: Concepts Related To Therapeutic Management In Obstructive Sl...mentioning

confidence: 99%

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

Kiss,

Neagos,

Jimborean

et al. 2023

Medicina

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Introductions: The global prevalence of obstructive sleep apnea shows that this disease appears in 1 billion people, with the prevalence exceeding 50% in some countries. Treatment is necessary to minimize negative health impacts. Obstructive sleep apnea (OSA) is defined as a cause of daytime sleepiness, as well as a clinical manifestation of sleep-disordered breathing. In the literature, there are numerous controversial studies regarding the etiology of this condition, but it is universally accepted that reduced activity in the upper airway muscles plays a significant role in its onset. Additionally, OSA has been associated with a series of comorbidities, such as type II diabetes, metabolic syndrome, and cardiovascular and pulmonary conditions, as well as head and neck tumors, especially oropharyngeal and laryngeal tumors. This is a review of the subject of OSA that considers several aspects: an analysis of the comorbidities associated with OSA, the involvement of tumor pathology in the onset of OSA, and the association of OSA with various types of laryngeal cancers. Additionally, it includes an evaluation of postoperative and medical outcomes for patients with OSA and laryngeal tumors treated surgically and medically, including chemotherapy. Relevant Sections: By taking into consideration the stated objective, a systematic analysis of the available literature was conducted, encompassing the PubMed, Medline, and Scopus databases. The evaluation was based on several keywords, including head and neck cancer, diabetes, diabetic, overlap syndrome, cardiovascular conditions, laryngeal neoplasm, radiotherapy, and chemotherapy, as well as the concept of quality of life in laryngectomized patients and patients with OSA. Discussions: The review evaluates the involvement of OSA in the presence of comorbidities, as well as the increased incidence of OSA in patients with laryngeal cancer. It is important to note that surgical and post-surgical treatment can play a significant role in triggering OSA in these patients. Conclusions: The studies regarding the correlations between OSA, comorbidities, and head and neck tumors indicate a significantly increased risk of OSA in association with conditions such as diabetes, metabolic syndrome, cardiovascular diseases, and head and neck tumors, particularly laryngeal tumors. This association has a physio-pathological basis. The various surgical methods followed by radiation and chemotherapy for tumor treatment do not exclude an increased risk of developing OSA after treatment. This significantly influences the quality of life of patients who survive these types of tumors. Future directions: Due to the multiple comorbidities associated with OSA, the extension of polysomnography associated with investigations during sleep, such as drug-induced sleep endoscopy, represents a tendency for the early diagnosis of this pathology, which affects the quality of life of these patients. Patients with head and neck cancer are at high risk of developing obstructive sleep apnea; this is why it is necessary to expand the polysomnographic investigation of these patients after surgical procedures or after radiotherapy and chemotherapy.

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Cisplatin/docetaxel/fluorouracil

2022

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Severe obstructive sleep apnea after concurrent chemoradiotherapy for laryngeal and hypopharyngeal cancer managed by CPAP

Cited by 6 publications

References 13 publications

Impact of radiotherapy for head and neck cancer on obstructive sleep apnea: a prospective study

Impact of radiotherapy for head and neck cancer on obstructive sleep apnea: a prospective study

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

Cisplatin/docetaxel/fluorouracil

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