Improvement of obstructive sleep apnea after radiation therapy of vocal cord carcinoma

Abstract

A 52-year-old gentleman presented to the sleep clinic with a history of witnessed episodes of apnea, loud snoring, and moderate subjective sleepiness (Epworth Sleepiness Scale (ESS), 10). The patient reported an average time in bed of 6.5 h per night. Physical exam revealed a weight of 206 lbs, a body mass index of 30, a Mallampati class of 2 and tonsils class 2. The diagnostic polysomnogram showed moderate obstructive sleep apnea (apnzea–hypopnea index (AHI) = 24). The patient was prescribed a continuous positive airway pressure (CPAP) device at 13 cm H2O of pressure based on a titration polysomnogram. On one-month follow-up, the patient had very low adherence to CPAP treatment and subsequently stopped using it. The patient presented to his primary physician with a new onset of intermittent hoarseness four months after his initial sleep evaluation. The patient was prescribed antibiotics and referred to an otolaryngologist, and was diagnosed with an invasive squamous cell carcinoma of the left true vocal cord (T2, N0, M0) (Fig. 1). The patient underwent an excisional biopsy and radiation therapy with 6075 centigray.