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A middle-aged man with history of squamous cell cancer of the base of the tongue, who was treated with chemoradiation and neck dissection 5 years ago, presented with loud snoring, gasping arousals at night and excessive daytime sleepiness with an Epworth Sleepiness Score of 15. He denied any diurnal respiratory symptoms. Routine follow-up since completion of cancer treatment revealed no evidence of disease recurrence and stable mild supraglottic oedema on laryngoscopic evaluation. Physical examination revealed a body mass index of 28.9 kg/m2, Mallampati II airway, firmness on the right side of his neck secondary to prior radiation therapy, no stridor and clear lung fields. A split-night diagnostic-titration study was performed and revealed severe obstructive sleep apnoea (OSA) with an oxygen saturation nadir of 50% (figure 1). Despite …
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