Case Report: Obstructive Sleep Apnea and Lhermitte’s Sign Following Chemoradiation in Head and Neck Cancer

Abstract
Background: Obstructive Sleep Apnea (OSA) and L' hermite Sign (LS) are known but uncommon manifestations of various general and local illnesses both non malignant and malignant ones. Screening the PubMed for studies linking either one or both of these manifestations with Head and Neck Cancers (HNCs) treated by concomitant radio chemotherapy found that few studies reporting on LS in association with chemo rather than radiotherapy. Even fewer those studies that reported on OSA and, perhaps only one case report that described simultaneous incidence of both of these morbidities in one patient, that was the present case report.
Case Report: The authors describe a case of locally advanced head and neck squamous cell carcinoma treated with chemo followed by concomitant chemoradiotherapy and developed an early post treatment simultaneous occurrence of OSA and LS both of them got improved after vitamin supplement, steroid and, Continuous Positive Airway Pressure (CPAP) therapy.
Conclusion: This case highlights the importance of keeping the doses of neurotoxic chemotherapeutic drugs mainly cispl-atin as low as possible when given concomitantly with radio-therapy in head and neck cancers also, the maximum dose to the spinal cord below 46 gray.