Voice Disorders in Obstructive Sleep Apnea: Prevalence, Risk Factors, and the Role of CPAP

Nelson Roy; Ray M Merrill; Jenny Pierce; Krishna M Sundar

doi:10.1177/0003489418819541

Voice Disorders in Obstructive Sleep Apnea: Prevalence, Risk Factors, and the Role of CPAP

Ann Otol Rhinol Laryngol. 2019 Mar;128(3):249-262. doi: 10.1177/0003489418819541. Epub 2018 Dec 21.

Authors

Nelson Roy¹, Ray M Merrill², Jenny Pierce¹, Krishna M Sundar³

Affiliations

¹ Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, USA.
² Department of Public Health, Brigham Young University, Provo, UT, USA.
³ Division of Pulmonary, Critical Care and Sleep Medicine, The University of Utah, Salt Lake City, UT, USA.

PMID: 30577715
DOI: 10.1177/0003489418819541

Abstract

Objective: Obstructive sleep apnea (OSA) is characterized by frequent interruptions in breathing related to upper airway collapse during sleep and may adversely affect phonatory function. This study aimed to: (1) establish the prevalence, risks, and quality of life burden of voice disorders in OSA and (2) explore the relation between voice disorders and positive airway pressure (PAP) therapy.

Study design: Cross-sectional, descriptive epidemiology study.

Methods: Analyses were based on 94 individuals with OSA (53 men, 41 women; mean age = 54.7 ± 12.8 years) who completed a telephone interview.

Results: Twenty-eight percent of participants reported having a current voice disorder. Of those with a current voice disorder, 83% had experienced symptoms for at least a year, and 58% had symptoms for at least 4 years. The prevalence of a current voice disorder was greater in women than men (44% vs 15%, P = .0020) but did not vary significantly across different age groups, body mass index (BMI), apnea/hypopnea index (AHI) severity, or medical history. After adjusting for sex, consistent use of PAP therapy (with humidification) was associated with (1) lower occurrence of voice disorders in women (Mantel-Haenszel [MH] χ²P = .0195), (2) reduced snoring severity accompanied by fewer voice disorders in men (MH χ²P = .0101), and (3) fewer reports of acid reflux as a possible trigger for voice problems (MH χ²P = .0226). Patients with OSA who also had a current voice disorder experienced lower overall quality of life compared to those without.

Conclusions: Chronic, longstanding voice disorders are common in women with OSA and produce significant adverse effects on quality of life. Nightly PAP use (with humidification) was associated with fewer voice symptoms and reduced severity of snoring and acid reflux as possible contributors. Further research is necessary to better understand the origin of these voice disorders in OSA and their potential response to treatment.

Keywords: CPAP; epidemiology; obstructive sleep apnea; voice disorders.

MeSH terms

Adult
Body Mass Index
Comorbidity
Continuous Positive Airway Pressure* / adverse effects
Cross-Sectional Studies
Female
Help-Seeking Behavior
Humans
Male
Middle Aged
Prevalence
Quality of Life
Risk Factors
Severity of Illness Index
Sex Distribution
Sleep Apnea, Obstructive / epidemiology*
Sleep Apnea, Obstructive / therapy*
Voice Disorders / epidemiology*
Voice Disorders / etiology
Voice Disorders / therapy
Young Adult