Can anatomical assessment of hypopharyngolarynx in awake patients predict obstructive sleep apnea?

Characteristics of obstructive sleep apnea syndrome in patients with partial laryngectomy

OBJECTIVES

The impacts of partial laryngectomy on sleep-disordered breathing were rarely investigated and reported in a limited number of patients. The aim of this study was to assess the prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) in patients with partial laryngectomy.

STUDY DESIGN

Case series.

METHODS

All patients undergoing partial laryngectomy by open approach (frontolateral vertical partial laryngectomy and supracricoid horizontal partial laryngectomy) for squamous cell carcinoma of the larynx between January 2006 and December 2019 were enrolled. Listed patients were contacted via telephone to propose participating in the study and plan a sleep study: self-assessments of sleep quality using the Pittsburgh Sleep Quality Index (PSQI) following a home sleep recording using respiratory polygraphy. Daytime sleepiness was also self-assessed by using the Epworth sleepiness scale.

RESULTS

Twenty patients with sleep record were included to the analyses. There were 11/20 patients (55%) diagnosed with moderate to severe OSASH. No relationship between OSAHS severity and age as well as body mass index (BMI) was observed. The Epworth sleepiness score was not necessarily high in patients with moderate/severe OSASH. Type of partial laryngectomy did not influence apnea-hypopnea index (AHI) results. There was no difference in terms of age, BMI, gender, type of partial laryngectomy, and the presence of adjuvant radiotherapy between two groups AHI < 15/h and AHI ≥ 15/h.

CONCLUSION

A sleep study screening for OSAHS should be considered in patients with partial laryngectomy in order to improve their sleep quality and quality of life even though they did not exhibit daily sleepiness and obesity.

Sleep Studies Interpretation and Application

Obstructive sleep apnea is a common, but under-recognized, condition. Polysomnography remains the gold standard for diagnosing obstructive sleep apnea and determining whether treatment is appropriate. The development of home sleep apnea testing has allowed for a faster and more convenient method of diagnosis. Continuous positive airway pressure is the therapy of choice for most patients with obstructive sleep apnea, but otorhinolaryngologists can expect to see more and more patients looking for alternative treatments. This review highlights salient points relevant to sleep study application and interpretation for otorhinolaryngologists.