by Andrew Day, MD MPH
What is it?
Early studies show many head and neck cancer survivors have trouble sleeping – in many cases this may be due to obstructive sleep apnea (OSA). When someone has OSA, their airway becomes blocked during sleep. Patients who are older, overweight, and male are more likely to have OSA. The effects of OSA can be severe. Patients are more likely to have car crashes, clouded thinking, high blood pressure, heart disease, and stroke. OSA can decrease your quality of life and can even be deadly.
How common is it among head and neck cancer patients?
Researchers are still trying to understand how common OSA is in head and neck cancer patients. Some early studies say that at least 25% of patients have OSA. Researchers think head and neck cancer patients are more likely to have OSA because tumor removal, reconstruction, and radiation may affect the structure and function of the upper airway.
What are the signs/symptoms?
Some common symptoms of OSA include snoring, gasping or choking during sleep, daytime sleepiness, trouble falling asleep, morning headaches, irritability, decreased concentration, and memory loss. Bed partners may see you temporarily stop breathing during sleep.
How is it diagnosed?
OSA is diagnosed by performing a sleep study. The sleep study measures the number of times your airway is blocked during sleep. It also measures your oxygen levels. Depending on your symptoms and test results, you may be diagnosed with mild, moderate, or severe OSA.
How is it treated?
OSA can be treated in many different ways. Simple treatments may work to open the nasal airway (i.e. breathe-right strips or medications to decrease swelling in the nose) or upper airway (i.e. sleeping in a more upright position, removing dentures, or using a special mouth guard). Weight loss by diet and exercise may also treat OSA.
More advanced treatments include use of machines or surgery. A portable CPAP (continuous positive airway pressure) machine constantly pushes air into your airway to help keep it open when you sleep. There are many surgical treatments for OSA. Airway surgery may be as simple as straightening the inside of your nose or as complex as breaking and moving your jaw bones. Weight-loss surgery is another, more complex option. In cases in which no other treatment works, doctors may recommend putting a breathing tube in the neck (tracheostomy tube).
Some of these options may not work as well in head and neck cancer survivors because of the airway changes caused by tumor removal, reconstruction, and/or radiation. As a result, CPAP is often one of the first treatments recommended by doctors.
When should I call my doctor?
Call your doctor if you have the symptoms described above.
Where can I learn more?
American Academy of Sleep Medicine
https://aasm.org/about/patient-info/
American College of Physicians
https://www.acponline.org/practice-resources/patient-education/online-resources/sleep
https://www.acponline.org/practice-resources/patient-education/online-resources/obstructive-sleep-apnea
References
Zhou J, Jolly S. Obstructive sleep apnea and fatigue in head and neck cancer patients. Am J Clin Oncol. 2015;38(4):411-414.
Cohen EE, LaMonte SJ, Erb NL, et al. American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA Cancer J Clin. 2016;66(3):203-239.
Epstein LJ, Kristo D, Strollo PJ, Jr., et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-276.
Jonas DE, Amick HR, Feltner C, et al. Screening for Obstructive Sleep Apnea in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. Jama. 2017;317(4):415-433.