Elsevier

Oral Oncology

Volume 42, Issue 1, January 2006, Pages 107-113
Oral Oncology

Prevalence of obstructive sleep apnoea following head and neck cancer treatment: A cross-sectional study

https://doi.org/10.1016/j.oraloncology.2005.06.022Get rights and content

Summary

The obstructive sleep apnoea–hypopnoea syndrome (OSAHS) is a sleep-related breathing disorder characterised by repetitive pharyngeal collapse. OSAHS is associated with a reduced quality of life. A high OSAHS prevalence has been reported in patients treated for head and neck cancer (HNC). The aim of the present study was to identify the prevalence of OSAHS within a Dutch population of patients treated for HNC. Consecutive HNC patients with a follow-up of 6 months to 5 years after treatment of an oral or oropharynx carcinoma were eligible for inclusion. Two questionnaires were used to assess the presence of OSAHS-related complaints. Subsequently, polysomnography was used in patients with OSAHS-related complaints to confirm the diagnosis of OSAHS. Four out of 33 included patients were diagnosed with OSAHS, yielding a prevalence of 12%. Since recognition and treatment of OSAHS might play an important role in improving quality of life of HNC patients, we suggest screening all patients with an oral or oropharynx carcinoma for the presence of OSAHS-related complaints prior to and following HNC treatment.

Introduction

The obstructive sleep apnoea–hypopnoea syndrome (OSAHS) is a sleep-related breathing disorder characterised by repetitive pharyngeal collapse. Pharyngeal collapse results in upper airway occlusion causing a cessation of or a reduction in ventilation during sleep (i.e., an apnoea or hypopnoea, respectively), in spite of ventilatory effort. To restore pharyngeal patency, and thus ventilation, patients have recurrent arousals from sleep with symphatic nervous system activation. These phenomena probably explain the cardiovascular problems (e.g. hypertension, coronary disease) and symptoms as excessive daytime sleepiness, increased risk of accidents and reduced quality of life, which are commonly associated with OSAHS.1

Abnormalities compromising the upper airway lumen may result in pharyngeal obstruction or collapse.2 For instance, tonsillar hypertrophy can give rise to OSAHS. Tonsillectomy has been reported to improve the condition.3, 4 Likewise, several case reports have been published of head and neck cancer (HNC) causing OSAHS in untreated patients, which improved following treatment of HNC.5, 6, 7 Conversely, some reports have suggested that the treatment of HNC itself may be a cause of OSAHS.8, 9, 10

The prevalence of OSAHS in the general population in the Netherlands has been reported to be 0.45% in a male population of 35 years or older.11 One study has reported OSAHS prevalence in a North American population of patients treated for HNC to be as high as 72.7% (i.e., 18–36 times higher than the general North American population).12 It has been reported that OSAHS patients have lower scores in several quality of life domains, with scores improving following adequate OSAHS treatment.13, 14, 15 With increasing numbers of HNC survivors over the past decades, focus within this population has shifted from survival to quality of life. Patients treated for HNC frequently report a reduction in quality of life.16 A relatively high prevalence of OSAHS within a population of patients treated for HNC would imply that recognition and treatment of OSAHS might play an important role in improving the quality of life in HNC patients.

The aim of the present study was to identify the prevalence of OSAHS within a Dutch population of patients treated for HNC.

Section snippets

Patients

All HNC patients who visited the Department of Oral and Maxillofacial Surgery of the University Medical Center Groningen from May to October 2004 for regular follow-up after treatment of a T2N0M0 or higher stage of oral- or oropharynx carcinoma were eligible for inclusion. Patients had to be treated either surgically, by a combination of surgery and radiotherapy or by radiotherapy alone. In addition, treatment had to be with curative intent with a follow-up period (i.e., interval from

Results

Out of 49 patients meeting the inclusion criteria 33 agreed to participate (23 men and 10 women; response rate 67%). Ages ranged from 38 to 87 years (mean ± SD, 62 ± 11 years). Body mass index ranged from 16 to 35 kg/m2 (mean ± SD, 25 ± 5 kg/m2). These and other patient characteristics are outlined in Table 2. Out of 33 participants, ten were considered to have OSAHS-related complaints (Table 3). Four out of these ten were diagnosed as having OSAHS, whereas three patients with OSAHS-related complaints

Discussion

The present study shows that the post-treatment OSAHS prevalence within the studied HNC population is at least 12%. This is 27 times higher then OSAHS prevalence in the general Dutch population, as reported by Neven et al. (Chi Squared, χ2 = 48.72, d.f. = 1; p < 0.001).11 Due to a lack of uniform definitions and differences in diagnostic techniques, OSAHS prevalence has been reported variably in literature. Neven et al. used a similar definition and protocol to determine OSAHS prevalence when

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      The average number of episodes of apnea and hypopnea per hour of sleep (AHI) was calculated as a summary measurement of OSA.1 Patients were considered to have OSA if the AHI value was >5.17 Traditional statistical analyses using χ2and Fisher exact tests were used to compare the test results of tongue-cancer patients with those of OSA sufferers in a normal population.

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