The prevalence of sleep apnea among patients with head and neck cancer is high, but the role of radiation and sleep apnea remains elusive. The purpose of this study was to evaluate sleep disordered breathing in these patients and the potential role of radiotherapy.
All patients with head and neck cancer who underwent polysomnogram from 7/1/2008 to 4/1/2009 were identified. Clinical history and polysomnographic data was reviewed retrospectively. Patients with head and neck cancers amenable to radiotherapy were included.
Of the 130 patients studied, 16 patients (2 female, 14 male) were identified with head and neck cancer. All patients underwent a sleep evaluation. Thirteen patients had completed treatment, 2 patients were receiving active chemotherapy, and 1 patient was receiving active chemoradiotherapy. One was referred for history of OSA, 1 had witnessed desaturation, 8 had sleep apnea symptoms, and 6 had fatigue/disrupted sleep. The median age was 61(41 to 87), and the median BMI was 27 kg/m2(21 to 37). Three patients had a history of sleep apnea. All but one patient received radiotherapy, and the time from the completion of radiation to the polysmonogram ranged from 47 days to 37 years(median 11.5 months). Three patients had split-night studies. One patient had a tracheostomy. All patients had significant sleep apnea with an AHI ranging from 7 to 100 (median 26). The Supine AHI/AHI ratio was higher in 13 patients and ranged from a 1.2 to 11 fold increase. One patient had significant central apnea. Eight patients underwent echocardiograms, and only one had a left ventricular dysfunction. Six patients underwent pulmonary function tests, and 3 had abnormalities of the flow-volume loop. One patient died within 3 months of cancer diagnosis.
Although radiotherapy is an important part of the treatment of head and neck cancer, there may be an association with the development of sleep disordered breathing.
Evaluation of patients who have received radiation to the head and neck should include a high level of suspicion for sleep apnea.
Saadia Faiz, No Financial Disclosure Information; No Product/Research Disclosure Information