Impact of free flap reconstruction on obstructive sleep apnea in patients with oral and oropharyngeal cancer

Fu-Hsin Liao; Chan-Chi Chang; Yu-Cheng Lu; Cheng-Yu Lin; Wei-Shu Lai

doi:10.1016/j.apjon.2022.100136

Impact of free flap reconstruction on obstructive sleep apnea in patients with oral and oropharyngeal cancer

Asia Pac J Oncol Nurs. 2022 Aug 28;9(10):100136. doi: 10.1016/j.apjon.2022.100136. eCollection 2022 Oct.

Authors

Fu-Hsin Liao¹, Chan-Chi Chang^{2

3}, Yu-Cheng Lu⁴, Cheng-Yu Lin^{1

2}, Wei-Shu Lai⁵

Affiliations

¹ Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Singsin Ear, Nose and Throat Clinic, Tainan, Taiwan.
⁵ Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Abstract

Objective: Little is known about the association between obstructive sleep apnea (OSA) and oral and oropharyngeal cancers (OOCs). This study aims to investigate the incidence and severity of OSA in patients with OOCs before and 6 months after free flap reconstruction (FFR), as well as identify the factors that affect the severity of OSA.

Methods: A prospective cohort study was designed. We recruited patients aged ≥ 20 years who were newly diagnosed with OOC and underwent FFR surgery at a medical center. Demographic data, cancer characteristics, and objective full-night polysomnographic parameters were collected. The Spearman rank correlation coefficient or the Kruskal-Wallis test was used for analyses.

Results: In the 23 included patients, the incidence of OSA was 91.3% before surgery and 95.6% as of 6 months after surgery. The proportion of patients with moderate OSA (apnea-hypopnea index (AHI) 15-29) or severe OSA (AHI ≥ 30) had increased from 52.2% to 78.3%, and the AHI was significantly increased (23.3 ± 17.6 vs. 34.6 ± 19.3, P = 0.013) as of 6 months after surgery. Neck circumference and treatment type were significantly correlated with preoperative and 6-month postoperative AHI, respectively.

Conclusions: Patients with OOCs had a high incidence of OSA before and after surgery. OOC survivors should undergo early OSA assessment and receive pre- and post-FFR OSA management to improve their quality of life.

Keywords: Free flap reconstruction surgery; Obstructive sleep apnea; Oral and oropharyngeal cancers; Polysomnography.