Bidirectional Relationship between Obstructive Sleep Apnea and Head and Neck Cancer: A Systematic Review of Current Evidences

Abdullah A Alamri; Alhassan Abdullah B  Almakrami; Reem Fahad Hawkash; Solaf Alhassan Alsedran; Mohammed Ibrahim A  Almakrami; Faisal Mofareh Assiri; Jumanah Abdullah  Al Fadhil; Jawharah Salem S  Alkorbi; Muath H.  Alqesair

doi:10.54293/smhj.v6i2.198

Authors

Abdullah A Alamri Otolaryngology head & Neck surgery department, Taibah University, Madinah, KSA.
Alhassan Abdullah B Almakrami Medical intern, Najran University, KSA. https://orcid.org/0009-0009-0390-2337
Reem Fahad Hawkash Intern -Najran university, KSA. https://orcid.org/0009-0009-9006-7121
Solaf Alhassan Alsedran Medical student- Najran University, KSA. https://orcid.org/0009-0006-1115-7689
Mohammed Ibrahim A Almakrami Medical Intern, Najran University, Najran City , KSA.
Faisal Mofareh Assiri Intern, Najran University. Najran, KSA.
Jumanah Abdullah Al Fadhil Medical student, Najran University, Najran City, KSA.
Jawharah Salem S Alkorbi Medical student, Najran University, Najran City, KSA.
Muath H. Alqesair Medical School, University of Szeged Albert Szent-Györgyi, Szeged, HUN. https://orcid.org/0009-0007-6923-7929

DOI:

https://doi.org/10.54293/smhj.v6i2.198

Keywords:

Obstructive Sleep Apnea; Head and Neck Neoplasms; Squamous Cell Carcinoma of Head and Neck; Bidirectional Relationship

Abstract

A growing body of evidence suggests a complex, bidirectional relationship between obstructive sleep apnea (OSA) and head and neck cancer (HNC), though the literature remains fragmented. This systematic review consolidates current evidence to examine this dual association, exploring both the impact of OSA on HNC biology and outcomes, and the role of HNC and its treatment in the development or exacerbation of OSA. A systematic search of PubMed/MEDLINE, Embase, Cochrane Central, and Web of Science was conducted from January 2021 to December 2025 in accordance with PRISMA guidelines. Observational and interventional studies investigating OSA as an exposure for HNC outcomes, or HNC/treatment as an exposure for OSA outcomes, were included. Study quality was assessed using the Newcastle-Ottawa Scale. Five studies met the inclusion criteria. The evidence demonstrates an alarmingly high prevalence of OSA in HNC populations, both pre- (up to 90%) and post-treatment (up to 72%). For the direction of OSA influencing HNC, pre-treatment OSA severity (Apnea-Hypopnea Index) was significantly correlated with larger primary tumor size and associated with increased tumor recurrence and mortality in one study. OSA was also linked to worse patient-reported outcomes during radiotherapy. For the reverse direction, HNC treatment (particularly radiotherapy) was strongly implicated in causing or perpetuating OSA, with studies showing persistent high OSA rates post-treatment despite anatomical changes, indicating iatrogenic, treatment-induced pathophysiology. Current evidence supports a bidirectional relationship between OSA and HNC. HNC treatment is a significant risk factor for OSA, creating a major survivorship concern. Preliminary evidence suggests pre-existing OSA may be associated with more aggressive tumor behavior and worse treatment tolerance.