OSA in patients with head and neck cancer is associated with cancer size and oncologic outcome
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HEAD AND NECK
OSA in patients with head and neck cancer is associated with cancer size and oncologic outcome Tilman Huppertz1 · Vera Horstmann1 · Charlotte Scharnow1 · Christian Ruckes2 · Katharina Bahr1 · Christoph Matthias1 · Haralampos Gouveris1 Received: 3 July 2020 / Accepted: 4 September 2020 © The Author(s) 2020
Abstract Purpose Obstructive sleep apnea (OSA) is associated with severe daytime sleepiness and reduced quality of life. These symptoms are also present in patients with squamous cell carcinoma of the head and neck (SCCHN) before, during and after treatment, so that comorbidity cannot be excluded. The aim was to evaluate the prevalence of OSA and its impact on the quality of life in patients with oropharyngeal, hypopharyngeal and lateral tongue SCCHN in a prospective study. Methods We performed cardiorespiratory home sleep apnea testing and recorded sleep-related patient-reported outcomes in 33 patients with confirmed oropharyngeal, hypopharyngeal and lateral tongue SCCHN. We correlated the sleep-related variables to oncologic variables and endpoints. Results Five female and 28 male patients with SCCHN (aged 46–77 years) were recruited. Thirty patients (90%) had OSA as defined by an Apnea/Hypopnea Index (AHI) > 5 /h before treatment. Evaluation after treatment, which was possible in 17 patients, showed OSA in 16 patients (94%). Radiologic primary tumor size showed significant positive correlation with AHI and apnea-index. Tumor recurrence and tumor-related mortality showed significant positive association with AHI. PSQI of these patients showed at least a moderate sleep disturbance. EORTC QLQ c30 questionnaire showed reduced values for all tested qualities, in particular for fatigue, insomnia, pain and financial distress. Conclusion Obstructive sleep apnea is a significant comorbidity in patients with SCCHN. Pre-interventional AHI may be correlated with the oncologic outcome. Further research is needed to further describe the course of OSA and its treatment before, during and after therapy. Keywords Obstructive sleep apnea · Head and neck cancer · Quality of life · Cardiorespiratory home sleep apnea testing
Introduction Obstructive sleep apnea (OSA) affects almost 50% of the male and almost 25% of the female adult population in Western Europe [1], with similar figures worldwide [2]. It may be associated with daytime sleepiness, missing sense of recovery after sleep and fatigue. OSA is independently * Tilman Huppertz Tilman.huppertz@unimedizin‑mainz.de 1
Sleep Center of the Department of Otorhinolaryngology‑ Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
2
associated with an increased risk of developing metabolic syndrome, hypertension, incident coronary heart disease or heart failure, diabetes, stroke and depression [1, 3–8]. Sleep-disordered breathing is associated w
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