title: Sleep-related breathing disorders in patients with tumors in the head and neck region.
abstract: BACKGROUND
  Sleep disturbance is a prominent complaint of cancer patients. Most studies have focused on insomnia and cancer-related fatigue. Obstructive sleep apnea (OSA) has been reported in small studies and case reports.
  
  
  METHODS
  In a retrospective review of patients who underwent formal sleep evaluation and polysomnography (PSG) from 2006 to 2011, 56 patients with tumors in the head and neck region were identified. Clinical characteristics, sleep-related history, and PSG data were reviewed.
  
  
  RESULTS
  Most patients had active cancer (80%), and the majority had squamous pathology (68%). Prominent symptoms included daytime fatigue (93%), daytime sleepiness (89%), and snoring (82%). Comorbid conditions primarily included hypertension (46%) and hypothyroidism (34%). Significant sleep-related breathing disorder was noted in 93% of patients, and 84% met clinical criteria for OSA. A male predominance (77%) was noted, and patients were not obese (body mass index <30 kg/m(2) in 52%). The majority of patients (79%) underwent radiation prior to sleep study, of which 88% had OSA, and in the group without prior radiation, 67% had OSA. Adherence to positive airway pressure (PAP) therapy was slightly better when compared with the general population. A subset of patients with persistent hypoxia despite advanced forms of PAP required tracheostomy. Multivariate analysis revealed that patients with active disease and radiation prior to PSG were more likely to have OSA.
  
  
  CONCLUSIONS
  Sleep-related breathing disorder was common in patients with tumors in the head and neck region referred for evaluation of sleep disruption, and most met clinical criteria for OSA. Daytime fatigue and sleepiness were the most common complaints. OSA was prevalent in male patients, and most with OSA were not obese. Architectural distortion from the malignancy and/or treatment may predispose these patients to OSA by altering anatomic and neural factors. A heightened clinical suspicion for sleep-related breathing disorder and referral to a sleep specialist would be beneficial for patients with these complaints.
authors.affiliation: Departments of Pulmonary Medicine, Head & Neck Surgery, Biostatistics, Radiation Oncology, and Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA safaiz@mdanderson.org.
authors.forename: Saadia A
authors.initials: SA
authors.lastname: Faiz
authors.affiliation: Departments of Pulmonary Medicine, Head & Neck Surgery, Biostatistics, Radiation Oncology, and Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Diwakar
authors.initials: D
authors.lastname: Balachandran
authors.affiliation: Departments of Pulmonary Medicine, Head & Neck Surgery, Biostatistics, Radiation Oncology, and Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Hessel
authors.affiliation: Departments of Pulmonary Medicine, Head & Neck Surgery, Biostatistics, Radiation Oncology, and Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Xiudong
authors.initials: X
authors.lastname: Lei
authors.affiliation: Departments of Pulmonary Medicine, Head & Neck Surgery, Biostatistics, Radiation Oncology, and Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Beth M
authors.initials: BM
authors.lastname: Beadle
authors.affiliation: Departments of Pulmonary Medicine, Head & Neck Surgery, Biostatistics, Radiation Oncology, and Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: William N
authors.initials: WN
authors.lastname: William
authors.affiliation: Departments of Pulmonary Medicine, Head & Neck Surgery, Biostatistics, Radiation Oncology, and Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Lara
authors.initials: L
authors.lastname: Bashoura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure; D005221:Fatigue / Q000209:etiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000532:radiotherapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000150:complications / Q000532:radiotherapy; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000628:therapy; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000628:therapy
keywords: Cancer; Head and neck squamous cell carcinoma; Head and neck tumors; Obstructive sleep apnea; Polysomnography; Radiation therapy; Sleep disruption; Sleep-related breathing disorder