Obstructive Sleep Apnea in Head and Neck Cancer Survivors: A Systematic Review and Meta‐Analysis

TL;DR

This study finds that head and neck cancer survivors have a high risk of obstructive sleep apnea, which increases after treatment.

Contribution

The first systematic review and meta-analysis on obstructive sleep apnea risk in head and neck cancer survivors.

Findings

Obstructive sleep apnea prevalence is 83.7% in head and neck cancer survivors.

Apnea-hypopnea index increases significantly after treatment.

Risk of obstructive sleep apnea is high regardless of treatment modality.

Abstract

The purpose of this study is to perform the first systematic review and meta‐analysis examining the risks of obstructive sleep apnea in head and neck cancer survivors with the goal of determining if there is a statistically significant increase in the risk of obstructive sleep apnea after treatment for head and neck cancer. Additionally, we sought to determine if specific treatment modalities are associated with an increased risk of obstructive sleep apnea.

A comprehensive literature search was performed using Embase, Ovid MEDLINE, Web of Science, and Ovid All EBM Reviews.

Included studies performed polysomnography in head and neck cancer patients before and/or after treatment. Random effects meta‐analyses were used to estimate overall prevalences of obstructive sleep apnea and apnea‐hypopnea index change before versus after head and neck cancer treatment.

The literature search returned 575 articles for initial review, of which 16 articles met criteria for inclusion and meta‐analysis (419 participants). The mean obstructive sleep apnea prevalence in head and neck cancer survivors was 83.7%. Mean prevalence before treatment was 79.9% [70.0%, 88.3%] and after treatment was 88.7% [82.3%, 94.0%]. In random effects meta‐analysis, patients had a statistically significant increase in apnea‐hypopnea index of 4.28 [0.46, 8.09] after treatment.

There is a high prevalence of obstructive sleep apnea in head and neck cancer survivors independent of treatment modality. Therefore, we propose that all head and neck cancer survivors undergo routine validated screening for obstructive sleep apnea.

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