Risk of obstructive sleep apnea after treatment of head and neck squamous cell carcinoma: a cross-sectional study

J Clin Sleep Med. 2022 Jun 1;18(6):1681-1686. doi: 10.5664/jcsm.9954.


Study objectives: Head and neck squamous cell carcinoma (HNSCC) or its treatment may be associated with an increased risk of obstructive sleep apnea (OSA). However, reported relationships between OSA risk factors and HNSCC are inconsistent. This study examined associations between tumor variables and risk of OSA at least 1 year after completion of treatment for HNSCC.

Methods: This cross-sectional study included HNSCC patients of a large academic medical center. Inclusion criteria were age ≥ 18 years, cancer free for at least 1 year, and absence of tracheostomy or mental impairment. The STOP-BANG questionnaire, with a threshold ≥ 3, was used to classify HNSCC patients into elevated and low OSA risk. Tumor characteristics and treatment types were obtained from medical records. Descriptive statistics were used to compare characteristics between OSA risk groups. Unadjusted and age-adjusted logistic and linear regression models were used to explore associations between exposures and OSA risk.

Results: Among 67 participants, 85% were males, mean age was 62.0 years (8.0 standard deviation), mean body mass index was 28.7 kg/m2 (4.6 standard deviation), and mean neck circumference was 16.3 inches (1.2 standard deviation). Three-quarters of participants received chemoradiation only. Elevated OSA risk was observed in 60% of the participants. Tumor location, tumor stage, and type of cancer treatment were not different between OSA risk groups. Hyperlipidemia was more common in the elevated OSA risk group vs the low-risk group (n = 16, 40% vs n = 2, 7%, P = .004). Age-adjusted analysis showed a trend toward 2-fold increased odds of elevated OSA risk in patients with tumors at the base of the tongue in comparison to other locations (odds ratio = 2.3, 95% confidence interval 0.9, 6.4). No associations between tumor stage, cancer treatment, and elevated OSA risk were observed.

Conclusions: Elevated OSA risk was common after HNSCC treatment. However, measured HNSCC characteristics generally were not different between elevated and low OSA risk groups. Given the high frequency of OSA that appears likely to exist in HNSCC patients, clinicians should inquire about OSA features in patients with a history of HNSCC.

Citation: Gavidia R, Dunietz GL, O'Brien LM, et al. Risk of obstructive sleep apnea after treatment of head and neck squamous cell carcinoma: a cross-sectional study. J Clin Sleep Med. 2022;18(6):1681-1686.

Keywords: cancer treatment; head and neck squamous cell carcinoma; obstructive sleep apnea; tumor location; tumor stage.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Cross-Sectional Studies
  • Female
  • Head and Neck Neoplasms* / complications
  • Head and Neck Neoplasms* / epidemiology
  • Head and Neck Neoplasms* / therapy
  • Humans
  • Male
  • Middle Aged
  • Sleep Apnea, Obstructive* / complications
  • Sleep Apnea, Obstructive* / epidemiology
  • Sleep Apnea, Obstructive* / therapy
  • Squamous Cell Carcinoma of Head and Neck / therapy
  • Surveys and Questionnaires