Page 96 - Portuguese Journal - SPORL - Vol 61. Nº2
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of the diagnosis, 55 patients had undergone no benefits and cause anxiety to the patient.
polysomnography and 22 patients were Considering these two clinical cases and
receiving treatment with continuous positive the literature review, some clinical scenarios
airway pressure (CPAP). 8 should raise suspicion of neoplastic disease
These two clinical cases are paradigmatic as the cause of snoring and sleep apnea and
examples of this issue. In the first case, the lead to an evaluation or re-evaluation of the
patient had been experiencing snoring and aerodigestive tract, namely: recent symptoms
apnea for one month, as witnessed by his in a patient with no risk factors; worsening
spouse, with recent worsening. Pharyngeal of symptoms without apparent cause; no
globus was also reported during the improvement or worsening of symptoms
consultation. The final diagnosis was follicular in patients undergoing ventilation therapy;
lymphoma of the tonsil. Palatine tonsil and symptoms suggestive of a neoplasm of
lymphomas are the malignant neoplasms the aerodigestive tract, namely dysphagia,
that present the most frequently with OSAS. dysphonia, pharyngeal globus, and weight
8
This fact may be related to tumor growth often loss.
being limited by the tonsillar capsule, which
leads to airway narrowing that is similar to that Role of the otorhinolaryngologist
seen in benign tonsillar hypertrophy. In this The clinical cases and literature review
10
case, the tumor was classified as high-grade presented herein support the need to review
follicular lymphoma (3B), which grows faster the existing approach to obstructive sleep
than most lymphomas , thus explaining the disorders. Head and neck tumors are rarely
relatively rapid worsening of the symptoms. considered as a differential diagnosis of
Moreover, local or additional systemic snoring and OSAS because the prevalence
symptoms are often absent in the initial of these symptoms has not been studied in
stages of indolent lymphomas (including patients with head and neck tumors.
follicular lymphoma). Fatigue is a frequently With sleep disorders being recognized by the
11
reported symptom in hematological diseases; scientific community and patients themselves,
however, the immediate improvement in the it is expected that these symptoms will be
patient’s complaints after surgery favors a increasingly acknowledged and, consequently,
causal relationship with the presence of OSAS. a larger number of associated diseases
In the second clinical case, the final diagnosis will be identified. An adequate diagnostic
was squamous cell carcinoma of the tonsil, approach to sleep disorders can facilitate
which is more frequently of an infiltrative the identification of prevalent etiologies and
nature than lymphoma. In this patient, fast exclude serious associated diseases, including
10
macroscopic growth of the lesion was observed neoplastic diseases.
during the period between diagnostic Assessment by sleep surgeons, including
suspicion and surgery, which suggested otorhinolaryngologists, is only “recommended”
strong local aggressiveness, leading to a quick by the American Academy of Sleep Medicine
diagnosis. for adults with OSAS and BMI < 30 who are
None of the patients reported previous intolerant or do not accept or adhere to
episodes of snoring or sleep apnea and both treatment with CPAP, and is “suggested” for
experienced a relatively rapid and progressive patients with a major anatomic variation of
worsening of OSAS. With the exception of the airway. This approach may be insufficient
12
excessive weight, no other risk factors for and exclude patients who would benefit from
OSAS were identified. Because there was observation by an otorhinolaryngologist.
complete resolution of the symptoms after Polysomnography allows a formal diagnosis
tonsillectomy, polysomnography was not of OSAS and is becoming increasingly
performed as it would add to the costs with accessible. The efficacy and availability of
238 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
