Sleep and quality of life in head and neck neoplasm

Abstract

What is the relationship between obstructive sleep apnea (OSA) and head and neck neoplasms (HNN)? For relevant articles identified through MEDLINE, thirty-three were about neoplasms (often benign) presenting first as OSA, and five were about head and neck cancer (HNC) treatment causing OSA. Three of these articles gave incidences for HNC treatment causing OSA, but these incidences varied widely, as they went from 8 to 92%. A few, older case studies described individual patients treated for HNC who developed OSA, particularly after extensive radiotherapy. However, those case studies did not stimulate much further investigation. Handling of OSA caused by HNN fits the classic, medical pattern of a symptom that is traced to a disease for which treating the disease removes the symptom (the treatment typically is to remove the HNN). OSA secondary to treatment for HNC may be missed, in part, because patients have many, permanent, adverse effects, such as xerostomia, from HNC treatment, and those adverse effects camouflage the OSA symptoms. OSA that has been caused by the treatment for HNC has been managed by tracheostomy or Continuous Positive Airway Pressure (CPAP), although patient complications may require additional steps. Quality of life surveys confirm that patients with HNC have sleep problems. Xerostomia may contribute to these sleep problems, and the role of salivary mucins deserves consideration. HNN and their treatments create special situations for studying the causes of OSA and for caring for patients. © 2008 Humana Press, Totowa, NJ.