Swallowing Function During Sleep in Patients with Head and Neck Cancer: A Polysomnographic Comparison with Matched Controls

Purpose We hypothesized that patients with head and neck cancer (HNC) have impaired pharynglaryngeal function during sleep compared with individuals without HNC, making them more susceptible to aspiration. We assumed polysomnography (PSG) would reveal decreased swallowing frequency, prolonged swallowing duration, reduced submental electromyographic (EMG) amplitude during swallowing, and abnormal timing of swallowing relative to respiratory phases.

Patients and Methods Patients with HNC who underwent radiotherapy to the pharyngolaryngeal region were enrolled. Age-, sex-, and body mass index-matched individuals without HNC served as controls. Swallowing frequency, duration, submental EMG amplitude during swallowing, and respiratory phases before and after swallowing were assessed using PSG and compared between groups. Data normality was assessed using the Shapiro-Wilk test, appropriate parametric or nonparametric analyses were applied with statistical significance set at p < 0.05.

Results Fifteen male patients with HNC and matched controls were analyzed. Swallowing frequency during sleep was significantly higher in the HNC group overall (p = 0.016), during rapid eye movement (REM) sleep (p = 0.033), and during non-REM sleep (p = 0.015). Swallowing duration during wakefulness was longer in the HNC group (p = 0.015), while no significant difference was observed during sleep (p = 0.73). Submental EMG amplitude during swallowing significantly decreased during sleep in the HNC group (p = 0.025). Respiratory pauses before and after swallowing were more frequent in the HNC group (p = 0.002 and p = 0.013, respectively).

Conclusion Swallowing function during sleep may be impaired in patients with HNC. Because the pharyngolaryngeal muscles are common to both swallowing and airway patency, dysfunction in this region may contribute to OSA-related breathing disturbances. Early identification and management of OSA, combined with targeted swallowing rehabilitation, may help reduce the risk of aspiration, improve airway safety, and potentially lower the risk of life-threatening complications, including sudden death.