Obstructive Sleep Apnea in Patients With Oral and Oropharyngeal Cancer Undergoing Free Flap Reconstruction: A Longitudinal Study With Computed Tomography

Background: Obstructive sleep apnea (OSA) often worsens in head and neck cancer patients post-treatment. Its relationship with airway morphology after free flap reconstruction in oral/oropharyngeal cancer (OOC) remains unclear. This study longitudinally explored OSA severity and airway changes in OOC patients post-reconstruction. Methods: Twenty six male OOC patients underwent polysomnography and head/neck computed tomography scans before, 1 week after, and 6 months after free flap reconstruction. Airway volume/dimensions and OSA parameters were analyzed. Results: Upper airway volume, neck size, and total apnea-hypopnea index (AHI) significantly increased 1-week post-surgery. At 6 months, only the total AHI increase remained significant. Upper airway volume was found to have a positive influence on AHI. Conclusion: OSA worsened after free flap reconstruction with partial recovery by 6 months. Airway dimensions may play a different role in these patients than general OSA populations, warranting more aggressive OSA screening in this cohort.