Obstructive Sleep Apnea in Patients with Head and Neck Cancer—More than Just a Comorbidity?

Oral Cancer and Sleep Disturbances: A Narrative Review on Exploring the Bidirectional Relationship

Oral cancer is a common malignant tumor, and its incidence has steadily increased in recent years. Sleep disturbances, including insomnia and obstructive sleep apnea, are prevalent among patients with oral cancer and significantly impact their quality of life. Emerging research suggests a bidirectional relationship between oral cancer and sleep disorders. This article reviews how oral cancer induces or exacerbates sleep disorders, particularly obstructive sleep apnea (OSA), through factors such as pain, psychological stress, and treatment-related side effects (e.g., upper airway damage caused by chemotherapy, radiotherapy, or surgical interventions). Furthermore, it analyzes how sleep disorders may promote oral cancer progression via chronic inflammation, intermittent hypoxia, oxidative stress, and disruption of circadian rhythms. By elucidating these interactions, this review provides a theoretical foundation for optimizing clinical treatment plans through a holistic understanding of their shared pathophysiological mechanisms.

Mapping the comorbidome: A novel analysis of the associations between obstructive sleep apnea and its comorbidities in Colombia

IntroductionObstructive sleep apnea (OSA) is linked to a complex network of comorbidities, including cardiovascular, metabolic, neurological, and oncological diseases. The comorbidome visually maps disease associations, highlighting the interconnected comorbidities of OSA, whose incidence and severity are strongly correlated.MethodsA retrospective cohort study was conducted between 2005 and 2020 to identify the comorbidities most frequently associated with OSA through a comprehensive comorbidity map. The prevalence of each comorbidity was calculated as a percentage, and a detailed analysis was performed to examine the relationship between these comorbidities and the severity of OSA. This graphic represents all comorbidities with significant associations to OSA, where the size of each bubble is proportional to the prevalence of the disease within the cohort, and the proximity to the center reflects the strength of the association.ResultsA total of 3043 patients diagnosed with OSA were included, of whom 51.1% (1154/3043) had severe OSA, 29.2% (889/3043) had moderate OSA, and 19.7% (600/3043) had mild OSA. The average age was 57.6 years (SD ± 15.32), and 65.6% (1995/3043) were men. Among patients with mild OSA, hypertension was present in 48.0% (288/600), in moderate OSA in 53.0% (470/889), and in severe OSA in 58.5% (909/1554). Renal failure (OR: 9.39; 95% CI: 3.7-23.84), cardiovascular disease (OR: 7.73; 95% CI: 3.92-15.21), dementia (OR: 6.98; 95% CI: 2.85-17.11), hemiplegia/stroke sequelae (OR: 6.90; 95% CI: 2.02-23.51), smoking (OR: 5.54; 95% CI: 2.74-11.21), and diabetes (OR: 4.34; 95% CI: 2.02-9.35) were associated with mild OSA. Hemiplegia/stroke sequelae (OR: 10.11; 95% CI: 3.8-26.89), cardiovascular disease (OR: 9.77; 95% CI: 6.18-15.46), chronic pulmonary disease (OR: 7.48; 95% CI: 4.76-11.77), and dementia (OR: 6.80;95% CI: 3.37-13.71) were associated with moderate OSA. Dementia (OR: 10.59; 95% CI: 6.41-17.5), leukemia and lymphoma (OR: 7.49; 95% CI: 2-28.1), chronic pulmonary disease (OR: 7.24; 95% CI: 5.33-9.83), hemiplegia or stroke sequelae (OR: 6.33; 95% CI: 3.3-12.16), and renal failure (OR: 6.10; 95% CI: 3.97-9.36) were associated with severe OSA.ConclusionThe most prevalent comorbidities were hypertension, smoking, and cardiovascular disease, with a higher incidence in patients with severe OSA. Additionally, a significant association was observed between certain comorbidities and mortality, particularly conditions such as renal failure and dementia. Malignant or neoplastic diseases were related to severe OSA.

Prevalence and assessment of sleep-disordered breathing in head and neck cancer patients: a systematic review

STUDY OBJECTIVES

Sleep-disordered breathing (SDB) is a very common and underdiagnosed condition in head and neck cancers (HNC) patients. If untreated, SDB can lead to negative health consequences. The identification of SDB in HNC patients is crucial to ensure appropriate treatment and to improve outcomes. The purpose of the study was to investigate the incidence of coexisting SDB in HNC patients and to evaluate methods of assessing SDB in the population.

METHODS

A systematic search of PubMed, Embase, CINAHL, Cochrane Database, the Web of Science, and Scopus was performed for studies related to SDB in HNC patients. In total, 1713 articles were identified. 19 articles were selected for qualitative synthesis. The studies involved 584 subjects.

RESULTS

The prevalence of SDB ranged from 57 to 90% before cancer treatment and from 12 to 96% after. When using an apnea-hypopnea index (AHI) cut-off ≥ 5/h to diagnosis SDB, the prevalence of SDB was 57-90% before cancer treatment and 12-94% after treatment. Sleep studies using polysomnography are the most commonly used assessment tools, but thresholds for diagnosis have been inconsistent.

CONCLUSIONS

There is a high prevalence of SDB in HNC patients. However, the diagnostic and thresholds methods used for detecting SDB vary widely. To determine the accurate prevalence of SDB, prospective, systematic studies of SDB in unselected cohorts of HNC participants are required.

Sleep Quality in Head and Neck Cancer

BACKGROUND

Patients with head and neck cancer often experience impaired sleep. Moreover, the treatment may negatively affect sleep quality. The aim of this observational study was to evaluate the sleep quality after treatment for head and neck cancer, and its relationship with quality of life and psychological distress.

METHODS

A total of 151 patients who underwent treatment for head and neck cancer at our department were included in the study. Quality of life, sleep quality, risk of sleep apnea, sleepiness, pain, and psychological distress were assessed by means of specific questionnaires.

RESULTS

The median follow-up was 30 months. Poor sleep quality was observed in 55.6% of the cases. An association between PSQI global sleep quality and EORTC global health status was found. The DT, HADS anxiety, and HADS depression scores were associated to PSQI global score, sleep quality, sleep latency, sleep disturbances, and daytime dysfunction.

CONCLUSIONS

Sleep disturbances, particularly OSA and insomnia, are frequent in HNC patients, and significantly impact their quality of life and psychological well-being. Given the effect of sleep on overall well-being, addressing sleep disorders should be a priority in the care of HNC patients.

Prevalence of obstructive sleep apnoea syndrome in oncological patients: A systematic review and meta-analysis

BACKGROUND

Obstructive sleep apnoea syndrome (OSAS) has garnered increasing attention in recent years due to its potential association with cancer. This systematic review and meta-analysis aimed to assess the prevalence of OSAS in cancer patients through a comprehensive analysis of existing literature.

METHODS

This systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, aimed to evaluate the prevalence of OSAS in cancer patients. A comprehensive search of electronic databases was performed to identify relevant studies published up to September 2021. Eligible studies reporting on the prevalence of OSAS in cancer patients, encompassing various study designs, were included in the analysis. Pooled estimates of the odds ratios (OR) with 95% confidence intervals (CIs) were calculated using a random effects model. Heterogeneity among the studies was assessed using the I2 statistic.

RESULTS

Seventeen studies fulfilled the inclusion criteria and were subsequently included in the review. The prevalence of OSAS in cancer patients was estimated to have an overall OR of 0.80 (95% CI: 0.75-0.85). In comparison with non-cancer patients, cancer patients had a statistically significant greater risk of OSAS, as indicated by the total estimated RR for the prevalence of OSAS in cancer patients, which was 0.89 (95% CI: 0.86-0.92). Nonetheless, there was a significant amount of heterogeneity (I2 = 96%) among the studies.

CONCLUSION

The overall data analysed in this review indicates that patients with cancer had far reduced likelihood of developing OSAS than individuals without cancer. However, the significant variation across the included studies highlights the need for additional investigation to fully clarify the complex association between OSAS and cancer incidence. These results emphasise how critical it is to identify OSAS as a possible comorbidity in cancer patients, one that should be taken into account for clinical management and ongoing research.

Comorbidities and Laryngeal Cancer in Patients with Obstructive Sleep Apnea: A Review

Introductions: The global prevalence of obstructive sleep apnea shows that this disease appears in 1 billion people, with the prevalence exceeding 50% in some countries. Treatment is necessary to minimize negative health impacts. Obstructive sleep apnea (OSA) is defined as a cause of daytime sleepiness, as well as a clinical manifestation of sleep-disordered breathing. In the literature, there are numerous controversial studies regarding the etiology of this condition, but it is universally accepted that reduced activity in the upper airway muscles plays a significant role in its onset. Additionally, OSA has been associated with a series of comorbidities, such as type II diabetes, metabolic syndrome, and cardiovascular and pulmonary conditions, as well as head and neck tumors, especially oropharyngeal and laryngeal tumors. This is a review of the subject of OSA that considers several aspects: an analysis of the comorbidities associated with OSA, the involvement of tumor pathology in the onset of OSA, and the association of OSA with various types of laryngeal cancers. Additionally, it includes an evaluation of postoperative and medical outcomes for patients with OSA and laryngeal tumors treated surgically and medically, including chemotherapy. Relevant Sections: By taking into consideration the stated objective, a systematic analysis of the available literature was conducted, encompassing the PubMed, Medline, and Scopus databases. The evaluation was based on several keywords, including head and neck cancer, diabetes, diabetic, overlap syndrome, cardiovascular conditions, laryngeal neoplasm, radiotherapy, and chemotherapy, as well as the concept of quality of life in laryngectomized patients and patients with OSA. Discussions: The review evaluates the involvement of OSA in the presence of comorbidities, as well as the increased incidence of OSA in patients with laryngeal cancer. It is important to note that surgical and post-surgical treatment can play a significant role in triggering OSA in these patients. Conclusions: The studies regarding the correlations between OSA, comorbidities, and head and neck tumors indicate a significantly increased risk of OSA in association with conditions such as diabetes, metabolic syndrome, cardiovascular diseases, and head and neck tumors, particularly laryngeal tumors. This association has a physio-pathological basis. The various surgical methods followed by radiation and chemotherapy for tumor treatment do not exclude an increased risk of developing OSA after treatment. This significantly influences the quality of life of patients who survive these types of tumors. Future directions: Due to the multiple comorbidities associated with OSA, the extension of polysomnography associated with investigations during sleep, such as drug-induced sleep endoscopy, represents a tendency for the early diagnosis of this pathology, which affects the quality of life of these patients. Patients with head and neck cancer are at high risk of developing obstructive sleep apnea; this is why it is necessary to expand the polysomnographic investigation of these patients after surgical procedures or after radiotherapy and chemotherapy.

Immunotherapy and Chemotherapy Versus Sleep Disturbances for NSCLC Patients

INTRODUCTION

Cancer patients are known to experience sleep disturbances that differ between disease stages and treatments. Regarding lung cancer patients and immunotherapy, information on their sleep disturbances has been recently acquired, but no comparison has been made between different treatment modalities.

PATIENTS AND METHODS

We recruited 98 non-small cell lung cancer patients; 49 had programmed death-ligand 1 expression of ≥50% and received immunotherapy as first-line treatment and 49 had programmed death-ligand 1 expression in the range from 0-49 and received chemotherapy as first-line treatment. All patients were stage IV, but with no bone metastasis. Sleep disturbances were recorded through polysomnography and sleep questionnaires.

RESULTS

For immunotherapy patients with PD-L1 expression ≥ 50%, the disease response was rapid and the sleep disturbances decreased rapidly. On the other hand, for chemotherapy patients, the sleep disturbances remained for all those patients that had partial response and stable disease. It was noticed that chemotherapy drugs induce severe adverse effects.

DISCUSSION

In our study, it was observed that patients with complete response had reduced sleep disturbances in the case of immunotherapy patients. However, sleep disturbances continued for several patients in the chemotherapy group due to the adverse effects of chemotherapy drugs.

IN CONCLUSION

Immunotherapy drugs on their own do not induce sleep disturbances and, through treatment response, alleviate sleep disturbances in lung cancer patients.

A Rare Kimura's Disease in the Oral Cavity with Severe Sleep Apnea: Case Report and Literature Review

Kimura's disease (KD) is a rare chronic inflammatory disorder that commonly occurs in Asian males. It mainly presents as painless subcutaneous masses or lymphadenopathy in the head and neck region. The incidence of KD in the oral cavity is quite rare. We reported a rare case of a 53-year-old male who had KD in his soft palate, hard palate and bilateral tonsils associated with severe sleep apnea. This patient underwent radiotherapy and exhibited a good response to the treatment. Throughout the 12-month follow-up period, the patient's condition remained satisfactory. Of the other 14 reviewed cases of KD in the oral cavity, the lesions can occur in the buccal mucosa, hard and soft palate, and mouth floor with specific clinical features. We further summarized their manifestations and treatments in order to guide the future identification and management of KD with lesions in the oral cavity.

Heart failure and cancer: From active exposure to passive adaption

The human body seems like a "balance integrator." On the one hand, the body constantly actively receives various outside stimuli and signals to induce changes. On the other hand, several internal regulations would be initiated to adapt to these changes. In most cases, the body could keep the balance in vitro and in vivo to reach a healthy body. However, in some cases, the body can only get to a pathological balance. Actively exposed to unhealthy lifestyles and passively adapting to individual primary diseases lead to a similarly inner environment for both heart failure and cancer. To cope with these stimuli, the body must activate the system regulation mechanism and face the mutual interference. This review summarized the association between heart failure and cancer from active exposure to passive adaption. Moreover, we hope to inspire researchers to contemplate these two diseases from the angle of overall body consideration.

Review of Under-Recognized Adjunctive Therapies for Cancer

Patients and providers may not be aware that several adjunctive measures can significantly improve the quality of life, response to treatment, and possibly outcomes for cancer patients. This manuscript presents a review of practical under-recognized adjunctive therapies that are effective including exercise; stress-reduction techniques such as mindfulness, massage, yoga, Tai Chi, breathing exercises; importance of sleep quality; diet modifications such as calorie restriction at the time of chemotherapy and avoidance of high carbohydrate foods; supplements such as aspirin, green tea, turmeric, and melatonin; and repurposed prescription medications such as metformin and statins. Each recommendation should be tailored to the individual patient to assure no contraindications.