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Tawfik GM, Mostafa EM, Alshareef A, Hmeda AB, Khaled S, Abdelwahed KA, Mahran SA, Agage HS, Amer AE, Emara NS, El-Qushayri AE, Ebied A, Huy NT. Association between radiotherapy and obstructive sleep apnea in head and neck cancer patients: A systematic review and meta-analysis. Auris Nasus Larynx 2021; 48:1126-1134. [PMID: 34112558 DOI: 10.1016/j.anl.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our aim was to investigate association between OSA and radiotherapy in head and neck cancer patients. METHODS On 9th of September 2018, we have searched 12 electronic databases to retrieve relevant studies. All eligible studies that assessed association between OSA and radiotherapy in head and neck cancer patients were included in our meta-analysis. Quality assessment of included studies was done using the NIH tools for cohort, cross-sectional and case series studies. RESULTS Fourteen studies met our study selection criteria, and six studies were eligible for our meta-analysis. There was no significant association between occurrence of OSA and radiotherapy in head and neck cancer patients (Odds ratio 1.54, 95% CI [0.66-3.60]; P = 0.322). CONCLUSION These findings point to no significant association between OSA risk and radiotherapy in head and neck cancer patients. We suggest more studies to be conducted to investigate any confounders that may influence the effect of radiotherapy on development of OSA in head and neck cancer patients.
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Affiliation(s)
- Gehad Mohamed Tawfik
- Faculty of Medicine, Ain Shams University, Cairo, Egypt; Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan
| | - Esraa Mahmoud Mostafa
- Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan; Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Abdulmueti Alshareef
- Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan; Faculty of Medicine, University of Zawia, Azzawiyah, Libya
| | - Almotsim Ben Hmeda
- Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan; Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Samar Khaled
- Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan; Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Khloud Amr Abdelwahed
- Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan; Faculty of Medicine, Misr University for Science and Technology, 6th of October City, Egypt
| | - Saleh Adel Mahran
- Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan; Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hesham Saeed Agage
- Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan; Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Esmail Amer
- Faculty of Medicine, Ain Shams University, Cairo, Egypt; Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan
| | - Nehad Samy Emara
- Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan; Faculty of Pharmacy, Zagazig University, Sharkia, Egypt
| | - Amr Ehab El-Qushayri
- Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan; Faculty of Medicine, Minia University, Minia, Egypt
| | - Amr Ebied
- Online Research Club (http://onlineresearchclub.org), Nagasaki 852-8523, Japan; Egyptian National Blood Transfusion Services, Cairo, Egypt
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan.
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Silva C, Iranzo A, Maya G, Serradell M, Muñoz-Lopetegi A, Marrero-González P, Gaig C, Santamaría J, Vilaseca I. Stridor during sleep: description of 81 consecutive cases diagnosed in a tertiary sleep disorders center. Sleep 2020; 44:5909297. [DOI: 10.1093/sleep/zsaa191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/02/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study Objectives
To describe the characteristics of stridor during sleep (SDS) in a series of adults identified by video-polysomnography (V-PSG).
Methods
Retrospective clinical, V-PSG, laryngoscopic, and therapeutic data of patients diagnosed with SDS in a tertiary referral sleep disorders center between 1997 and 2017.
Results
A total of 81 patients were identified (56.8% males, age 61.8 ± 11.2 years). Related etiologies were multiple system atrophy (MSA), amyotrophic lateral sclerosis, spinocerebellar ataxia type 1, anti-IgLON5 disease, fatal familial insomnia, brainstem structural lesions, vagus nerve stimulation, recurrent laryngeal nerve injury, the effect of radiotherapy on the vocal cords, cervical osteophytes, and others. Stridor during wakefulness coexisted in 13 (16%) patients and in MSA was only seen in the parkinsonian form. Laryngoscopy during wakefulness in 72 (88.9%) subjects documented vocal cord abductor impairment in 65 (90.3%) and extrinsic lesions narrowing the glottis in 2 (2.4%). The mean apnea–hypopnea index (AHI) was 21.4 ± 18.6 and CT90 was 11.5 ± 19.1. Obstructive AHI > 10 occurred in 52 (64.2%) patients and central apnea index >10 in 2 (2.4%). CPAP abolished SDS, obstructive apneic events and oxyhemoglobin desaturations in 58 of 60 (96.7%) titrated patients with optimal pressure of 9.0 ± 2.3 cm H20. Tracheostomy in 19 (23.4%) and cordotomy in 3 (3.7%) subjects also eliminated SDS.
Conclusions
SDS in adults is linked to conditions that damage the brainstem, recurrent laryngeal nerve, and vocal cords. V-PSG frequently detects obstructive sleep apnea and laryngoscopy usually shows vocal cord abductor dysfunction. CPAP, tracheostomy, and laryngeal surgery abolish SDS.
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Affiliation(s)
- Cristiana Silva
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Gerard Maya
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Mónica Serradell
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Amaia Muñoz-Lopetegi
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Paula Marrero-González
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Carles Gaig
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Joan Santamaría
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Isabel Vilaseca
- Otorhinolaryngology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Bunyola, Spain
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Ralli M, Campo F, Angeletti D, Allegra E, Minni A, Polimeni A, Greco A, de Vincentiis M. Obstructive Sleep Apnoea in Patients Treated for Head and Neck Cancer: A Systematic Review of the Literature. ACTA ACUST UNITED AC 2020; 56:medicina56080399. [PMID: 32784361 PMCID: PMC7466207 DOI: 10.3390/medicina56080399] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022]
Abstract
Background and objectives: Obstructive sleep apnoea (OSA) is clinically defined by signs of daytime sleepiness and objective measures of disordered breathing during sleep. The literature is still controversial on the incidence and aetiology of OSA secondary to head and neck cancer treatment. The aim of this systematic review is to evaluate and discuss the prevalence of OSA in patients treated with surgery and/or chemo/radiotherapy for head and neck cancer. Materials and methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was performed on May 2020 using the MEDLINE database, Scopus, and Google Scholar. The searches were conducted using combinations of the following terms: head and neck cancer, OSA, radiotherapy, chemotherapy, partial laryngectomy, laryngeal cancer, neoplasm, tumour, carcinoma, and oropharyngeal cancer. Results: Our results suggest that head and neck cancer patients have a higher incidence of OSA (59.78%) compared to the general population; differences may occur based on the type of treatment. Conclusions: Clinicians should recognise the higher prevalence of OSA in patients treated for head and neck cancer and should consider a comprehensive sleep history as part of the evaluation and management of these patients. Further research is needed to evaluate the exact prevalence, aetiology, and correct management of OSA after treatment for head and neck cancer.
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Affiliation(s)
- Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy; (F.C.); (D.A.); (A.M.); (A.G.)
- Correspondence: ; Tel.: +39-0649976808
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy; (F.C.); (D.A.); (A.M.); (A.G.)
| | - Diletta Angeletti
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy; (F.C.); (D.A.); (A.M.); (A.G.)
| | - Eugenia Allegra
- Otolaryngology Department of Health Science, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy; (F.C.); (D.A.); (A.M.); (A.G.)
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00185 Rome, Italy; (A.P.); (M.d.V.)
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy; (F.C.); (D.A.); (A.M.); (A.G.)
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00185 Rome, Italy; (A.P.); (M.d.V.)
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Huyett P, Kim S, Johnson JT, Soose RJ. Obstructive sleep apnea in the irradiated head and neck cancer patient. Laryngoscope 2017; 127:2673-2677. [DOI: 10.1002/lary.26674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/13/2017] [Accepted: 04/12/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Phillip Huyett
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Seungwon Kim
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Jonas T. Johnson
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Ryan J. Soose
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
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Abstract
Obstructive sleep apnea (OSA) is present in at least 2% of women and 4% of men, and its prevalence is increasing, because a major predisposing factor for OSA is a high body mass index. Psoriasis has the most strongly substantiated link with OSA, where the relationship may be bidirectional. Dermatologic disorders may be comorbid with OSA due to several factors: (i) the heightened proinflammatory state in OSA, which can occur independent of body mass index, and may exacerbate inflammatory dermatoses; (ii) intermittent hypoxemia may promote neovascularization and tumor growth in certain cancers, such as melanoma; (iii) obesity, present in majority of OSA patients, can be associated with a heightened proinflammatory state; (iv) upper airway obstruction due to local tumors or soft tissue swelling due to physical urticaria or angioedema; (v) acute nasal congestion in the atopic patient with allergic rhinitis; (vi) dermatologic disorders associated with other OSA risk factors (eg, acanthosis nigricans and metabolic syndrome); and (vii) a high sympathetic tone (eg, in atopic dermatitis) and resultant sleep fragmentation contributing to upper airway instability during sleep. In many instances, the dermatology patient with OSA may have other medical and psychiatric comorbidities that are also associated with increased OSA risk.
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Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6C 0A7, Canada; Psychmed Research, 585 Springbank Drive, Suite 101, London, Ontario, Canada, N6J 1H3.
| | - Fiona C Simpson
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6C 0A7, Canada; Psychmed Research, 585 Springbank Drive, Suite 101, London, Ontario, Canada, N6J 1H3
| | - Branka Vujcic
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6C 0A7, Canada; Psychmed Research, 585 Springbank Drive, Suite 101, London, Ontario, Canada, N6J 1H3
| | - Aditya K Gupta
- Department of Medicine, University of Toronto School of Medicine, 645 Windermere Road, London, Ontario, Canada, N5X 2P1
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Gilat H, Shpitzer T, Guttman D, Soudry E, Feinmesser R, Bachar G. Obstructive sleep apnea after radial forearm free flap reconstruction of the oral tongue. Laryngoscope 2013; 123:3223-6. [PMID: 23575744 DOI: 10.1002/lary.24125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/21/2013] [Accepted: 03/05/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine whether radial forearm free flap reconstruction of the tongue after partial glossectomy is associated with obstructive sleep apnea. STUDY DESIGN Retrospective case series. METHODS Fifteen patients (5 men, 10 women) treated for tongue cancer in 2006-2010 by partial glossectomy and immediate radial forearm free flap reconstruction completed the Epworth Sleepiness Scale and underwent polysomnographic studies. Background, clinical, and pathologic data were collected from the medical files. RESULTS Mean ± SD age of the study group was 57 ± 19 years; body mass index, 24 ± 4; follow-up, 5.6 ± 2.8 years. Mean ± SD Epworth scale score was 8.18 ± 6.18 (normal, <8). Disordered sleep was documented in 11 patients, of whom 8 (53.3% of the cohort) had OSA (5 mild, 2 moderate, 1 severe). The OSA rate was significantly higher than reported in the general population (P = 0.001). CONCLUSION Patients after partial glossectomy and radial forearm free flap reconstruction appear to be at high risk of obstructive sleep apnea. Testing for OSA should be considered in these patients.
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Affiliation(s)
- Hanna Gilat
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Chan MY, Chou MY, Lee LT, Cheng CS, Hsiao YL, Wong YK. Prevalence of obstructive sleep apnea in patients with squamous cell carcinoma of the tongue following ablation surgery. J Dent Sci 2012. [DOI: 10.1016/j.jds.2012.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Qian W, Haight J, Poon I, Enepekides D, Higgins KM. Sleep apnea in patients with oral cavity and oropharyngeal cancer after surgery and chemoradiation therapy. Otolaryngol Head Neck Surg 2010; 143:248-52. [DOI: 10.1016/j.otohns.2010.02.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 02/19/2010] [Accepted: 02/24/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE: To determine the point prevalence of sleep apnea in patients following oral and oropharyngeal cancer treatment at a major tertiary care referral center. STUDY DESIGN: A retrospective cross-sectional survey. SUBJECTS AND METHODS: Twenty-four patients with established oral or oropharyngeal cancer were submitted to overnight polysomnography. The surgical group consisted of 15 patients (11 male, 4 female; average age 64.2 yrs) having undergone primary surgery with radial forearm free flap reconstruction. The remaining patients (5 male, 4 female; average age 54.8 yrs) were treated nonsurgically with chemoradiation therapy. The fatigue-related daytime sleepiness was measured with the Epworth sleepiness scale (ESS). RESULTS: Eleven patients in the surgical group and three in the nonsurgical group had a respiratory disturbance index (RDI) greater than 15 (odds ratio = 5.5, P = 0.092). Twelve patients in the surgical group and five in the nonsurgical group had significant oxygen desaturation during sleep hours (odds ratio = 3.3, P = 0.356). There was no observed significant correlation between RDI and oxygen desaturation (r2 = 0.28), nor was there any observed association between the RDI and ESS score (r2 = 0.18). CONCLUSION: This preliminary study has suggested that surgical patients in our cohort have a higher prevalence of moderate to severe obstructive sleep apnea in the postoperative period, when tested, compared with a nonsurgical group. A small sample size and incomplete matching on important cofactors of interest, such as primary site location, body mass index, and thyroid function, limit this study. A pretreatment and post-treatment analysis is obviously required to demonstrate any significant level of association between treatment type and sleep apnea status. © 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.
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Verse T, Bodlaj R, de la Chaux R, Dreher A, Heiser C, Herzog M, Hohenhorst W, Hörmann K, Kaschke O, Kühnel T, Mahl N, Maurer JT, Pirsig W, Rohde K, Sauter A, Schedler M, Siegert R, Steffen A, Stuck BA; ArGe Schlafmedizin der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. [Guideline: Treatment of obstructive sleep apnea in adults]. HNO 2009; 57:1136-56. [PMID: 19855948 DOI: 10.1007/s00106-009-2013-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current guideline discusses conservative and surgical therapy of obstructive sleep apnea (OSA) in adults from the perspective of the ear, nose and throat specialist. The revised guideline was commissioned by the German Society of Ear-Nose-Throat, Head-Neck Surgery (DG HNO KHC) and compiled by the DG HNO KHC's Working Group on Sleep Medicine. The guideline was based on a formal consensus procedure according to the guidelines set out by the German Association of Scientific Medical Societies (AWMF) in the form of a"S2e guideline". Research of the literature available on the subject up to and including December 2008 forms the basis for the recommendations. Evaluation of the publications found was made according to the recommendations of the Oxford Centre for Evidence-Based Medicine (OCEBM). This yielded a recommendation grade, whereby grade A represents highly evidence-based studies and grade D those with a low evidence base.
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Kovács V, Teymoortash A, Werner JA, Lichtenberger G. Bilateral vocal cord paralysis associated with laryngeal myxedema. Eur Arch Otorhinolaryngol 2010; 267:565-70. [PMID: 19865822 DOI: 10.1007/s00405-009-1132-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 08/30/2009] [Indexed: 10/20/2022]
Abstract
For managing dyspnea caused by bilateral vocal cord paralysis as a complication of thyroidectomy in the acute postoperative period, reversible vocal cord lateralisation is performed at the authors' departments. However, in the later postoperative period of thyroidectomy when there is no chance for recovery of the recurrent laryngeal nerves, they perform irreversible procedure. Applying these operative techniques satisfactory breathing can be achieved in about 95% of cases avoiding tracheostomy. In 5% of cases there are other comorbidities in the background of unsuccessful operative results which can cause potential dyspnea as well. From these complications the authors emphasize the role of laryngeal obstruction and myxedema as a consequence of hypothyroidism developed after thyroidectomy. Management of severe dyspnea caused by association of these two complications of thyroidectomy means a great therapeutic challenge. Between 01 Jan 1989 and 30 Nov 2008 the authors performed 161 reversible and 135 irreversible vocal cord lateralisations to manage dyspnea caused by bilateral vocal cord paralysis as a complication of thyroidectomy. From these cases four patients had further obstruction due to laryngeal myxedema. By performing endoscopic laryngeal surgeries and applying levothyroxine replacement therapy sufficiently wide glottic chink has been achieved in all the cases. According to the experience of the authors dyspnea caused by bilateral vocal cord paralysis after thyroidectomy needs complex, interdisciplinary therapeutic approach beside glottis widening operations.
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Abstract
A growing body of literature is suggesting that there is a link between head and neck cancer treated with radiation therapy and the development of obstructive sleep apnea/hypopnea syndrome (OSAHS). We describe the case of a 54-year-old man with a history of head and neck cancer whose OSAHS had gone undiagnosed for 3 years. After the diagnosis was made on the basis of sleep study data, we determined that the OSAHS was a long-term complication of cervical radiation therapy that had been delivered to treat the patient's laryngeal squamous cell carcinoma 3 years earlier. We also review the literature regarding the association between head and neck cancer and the development of OSAHS.
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Affiliation(s)
- Thomas P. Stern
- From the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, MetroHealth Medical Center, Cleveland
| | - Dennis Auckley
- From the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, MetroHealth Medical Center, Cleveland
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Micke O, Bruns F, Mücke R, Schäfer U, Glatzel M, DeVries AF, Schönekaes K, Kisters K, Büntzel J. Selenium in the treatment of radiation-associated secondary lymphedema. Int J Radiat Oncol Biol Phys 2003; 56:40-9. [PMID: 12694822 DOI: 10.1016/s0360-3016(02)04390-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this explorative study was to evaluate the impact of selenium in the treatment of lymphedema after radiotherapy. MATERIALS AND METHODS Between June 1996 and June 2001, 12 patients with edema of the arm and 36 patients with edema of the head-and-neck region were treated with selenium for therapy-related lymphedema. Of these 36 patients, 20 had interstitial endolaryngeal edema associated with stridor and dyspnea. All patients received sodium selenite over 4 to 6 weeks. RESULTS Self-assessment using a visual analog scale (n = 48) showed a reduction of 4.3 points when comparing pre- and posttreatment values (p < 0.05). Of 20 patients with endolaryngeal edema, 13 underwent no tracheostomy, 5 underwent a temporary tracheostomy, and only 2 underwent a permanent tracheostomy. Ten of 12 patients with arm edema showed a circumference reduction of the edematous limb and improvement in the Skin-Fold Index by 23.3 points. An improvement of one stage or more was shown by the Földi or the Miller score (n = 28) in 22 (Földi score) and in 24 (Miller score) patients. CONCLUSIONS Treatment with sodium selenite is well tolerated and easy to deliver. Additionally, our results suggest that sodium selenite has a positive effect on secondary-developing lymphedema caused by radiation therapy alone or by irradiation after surgery.
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Affiliation(s)
- Oliver Micke
- Department of Radiotherapy, Münster University Hospital, Münster, Germany.
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Abstract
Solitary extramedullary plasmacytomas are uncommon neoplasms. They occur most frequently in the upper aerodigestive tract and account for 4% of the nonepithelial tumors in this site. The evolution of a plasmacytoma is unsteady and symptoms at presentation have included dystonia, dysphagia, oral pain, cough, and dyspnea on exertion. Plasmacytoma of the upper aerodigestive tract has not been previously reported as a cause of obstructive sleep apnea.
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Affiliation(s)
- R P Byrd
- Pulmonary Division, James H. Quillen College of Medicine, East Tennessee State University, Mountain Home, USA
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