November 2011


Obstructive sleep apnoea and snoring

Is examination necessary?

Volume 40, No.11, November 2011 Pages 886-888

Omar Mulla

Frank Agada

David Dawson

Sanjai Sood

This article outlines two cases of snoring and obstructive sleep apnoea (OSA) secondary to parapharyngeal space tumours. Both patients were referred to a specialist sleep clinic where oropharyngeal masses were seen and biopsied. Both underwent surgery and this was curative of both their snoring and their OSA. Parapharyngeal space tumours are an extremely rare cause of OSA and snoring. However, all patients with OSA and snoring should have a full head and neck examination before referral; in rare cases this could enable early detection of a parapharyngeal space tumour.

Case study 1

Walter, 60 years of age, presented with a 2 year history of worsening snoring, poor sleep quality and daytime somnolence. He was a nonsmoker. His wife revealed she had recently noticed a hyponasal quality to his voice. His body mass index (BMI) was 26. Walter was referred to a sleep clinic where oral cavity examination showed a right sided oropharyngeal mass (Figure 1). This was biopsied and confirmed to be a pleomorphic adenoma of the parotid gland. Overnight polysomnography showed an oxygen desaturation index of >31 (severe obstructive sleep apnoea [OSA]). Walter underwent surgical resection and both his snoring and sleep apnoea resolved.

Case study 2

Paul, 39 years of age, presented with a 2 year history of progressively worsening snoring. He was otherwise healthy, did not smoke and had no other complaints. His BMI was normal. Paul was referred to a sleep clinic where he was noted to have a large right sided oropharyngeal mass (Figure 2). Biopsy confirmed his mass to be a sarcoma. Overnight polysomnography showed an oxygen desaturation index of >31 (severe OSA). He underwent surgery and postoperative chemoradiotherapy and both his snoring and OSA resolved.

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