閉塞性睡眠時無呼吸症候群患者における合併症と喉頭癌：レビュー

Comorbidities and Laryngeal Cancer in Patients with Obstructive Sleep Apnea: A Review.

抄録

:閉塞性睡眠時無呼吸症候群の世界的な有病率を見ると、この疾患は10億人に見られ、有病率が50％を超える国もある。健康への悪影響を最小限に抑えるためには治療が必要である。閉塞性睡眠時無呼吸症候群（OSA）は、日中の眠気の原因であると同時に、睡眠呼吸障害の臨床症状として定義される。文献的には、この病態の病因については多くの議論があるが、上気道筋の活動低下がその発症に重要な役割を果たしていることは普遍的に認められている。さらに、OSAは、II型糖尿病、メタボリックシンドローム、心血管疾患、肺疾患などの一連の合併症や、頭頸部腫瘍、特に中咽頭腫瘍や喉頭腫瘍と関連している。本書は、OSAに関連する併存疾患の分析、OSA発症における腫瘍病態の関与、OSAと各種喉頭癌との関連など、いくつかの側面を考慮したOSAに関する総説である。さらに、化学療法を含む外科的および内科的治療を受けたOSAおよび喉頭腫瘍患者の術後および内科的転帰の評価も含まれている。頭頸部がん、糖尿病、オーバーラップ症候群、心血管疾患、喉頭新生物、放射線療法、化学療法、さらに喉頭摘出患者とOSA患者におけるQOLの概念など、いくつかのキーワードに基づいて評価した。OSA、併存疾患、頭頸部腫瘍の相関に関する研究では、糖尿病、メタボリックシンドローム、心血管疾患、頭頸部腫瘍、特に喉頭腫瘍などの疾患との関連で、OSAのリスクが有意に増加することが示されている。この関連は生理学的病理学的根拠がある。腫瘍治療のためのさまざまな外科的方法、それに続く放射線療法や化学療法は、治療後にOSAを発症するリスクの増加を排除するものではない。OSAには複数の合併症があるため、睡眠ポリグラフ検査や睡眠内視鏡検査などの睡眠中の検査が普及し、患者のQOLに影響を与えるこの病態の早期診断が可能になりつつある。頭頸部癌患者は閉塞性睡眠時無呼吸症候群を発症するリスクが高い。そのため、外科手術後や放射線治療・化学療法後にこれらの患者の睡眠ポリグラフ検査を拡大する必要がある。

: The global prevalence of obstructive sleep apnea shows that this disease appears in 1 billion people, with the prevalence exceeding 50% in some countries. Treatment is necessary to minimize negative health impacts. Obstructive sleep apnea (OSA) is defined as a cause of daytime sleepiness, as well as a clinical manifestation of sleep-disordered breathing. In the literature, there are numerous controversial studies regarding the etiology of this condition, but it is universally accepted that reduced activity in the upper airway muscles plays a significant role in its onset. Additionally, OSA has been associated with a series of comorbidities, such as type II diabetes, metabolic syndrome, and cardiovascular and pulmonary conditions, as well as head and neck tumors, especially oropharyngeal and laryngeal tumors. This is a review of the subject of OSA that considers several aspects: an analysis of the comorbidities associated with OSA, the involvement of tumor pathology in the onset of OSA, and the association of OSA with various types of laryngeal cancers. Additionally, it includes an evaluation of postoperative and medical outcomes for patients with OSA and laryngeal tumors treated surgically and medically, including chemotherapy. : By taking into consideration the stated objective, a systematic analysis of the available literature was conducted, encompassing the PubMed, Medline, and Scopus databases. The evaluation was based on several keywords, including head and neck cancer, diabetes, diabetic, overlap syndrome, cardiovascular conditions, laryngeal neoplasm, radiotherapy, and chemotherapy, as well as the concept of quality of life in laryngectomized patients and patients with OSA. : The review evaluates the involvement of OSA in the presence of comorbidities, as well as the increased incidence of OSA in patients with laryngeal cancer. It is important to note that surgical and post-surgical treatment can play a significant role in triggering OSA in these patients. : The studies regarding the correlations between OSA, comorbidities, and head and neck tumors indicate a significantly increased risk of OSA in association with conditions such as diabetes, metabolic syndrome, cardiovascular diseases, and head and neck tumors, particularly laryngeal tumors. This association has a physio-pathological basis. The various surgical methods followed by radiation and chemotherapy for tumor treatment do not exclude an increased risk of developing OSA after treatment. This significantly influences the quality of life of patients who survive these types of tumors. : Due to the multiple comorbidities associated with OSA, the extension of polysomnography associated with investigations during sleep, such as drug-induced sleep endoscopy, represents a tendency for the early diagnosis of this pathology, which affects the quality of life of these patients. Patients with head and neck cancer are at high risk of developing obstructive sleep apnea; this is why it is necessary to expand the polysomnographic investigation of these patients after surgical procedures or after radiotherapy and chemotherapy.