Advertisement

Thyroid Hormone Levels and TSH Activity in Patients with Obstructive Sleep Apnea Syndrome

Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 878)

Abstract

Obstructive sleep apnea syndrome (OSAS) is characterized by complete cessation of inspiratory flow (apnea) or upper airway airflow limitation (hypopnea) with increased respiratory muscle activity, which is repeatedly observed during sleep. Hypothyroidism has been described as a rare cause of OSAS, but it is considered to be the main cause of breathing disorders during sleep in patients in whom an improvement of OSAS is observed after thyroid hormone replacement therapy. Nevertheless, euthyreosis due to thyroxine replacement in patients with OSAS often does not improve the breathing disorder and treatment with continuous positive airway pressure is usually applied. The aim of this study was to assess thyroid function in patients with OSAS. We studied 813 patients in whom severe OSAS was diagnosed; the mean apnea-hypopnea index was 44.0. Most of the patients were obese (mean BMI 33.1 ± 6.6 kg/m2) and had excessive daytime sleepiness (ESS 12.8 ± 6.6). With the thyroid stimulating hormone (TSH) concentration as the major criterion, hypothyroidism was diagnosed in 38 (4.7 %) and hyperthyroidism was diagnosed in 31 (3.8 %) patients. Analysis of basic anthropometric data, selected polysomnography results, and TSH, fT3, and fT4 values did not reveal any significant correlations. In conclusion, the incidence of thyroid function disorders seems to be no different in OSAS than that in the general population. We did not find correlations between TSH activity and the severity of breathing disorders during sleep.

Keywords

fT3 fT4 Hyperthyroidism Hypothyroidism OSAS TSH 

Notes

Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.

References

  1. AASM (2014) American Academy of Sleep Medicine. http://www.aasmnet.org/practiceguidelines.aspx. Accessed on 27 Mar 2015
  2. Deegan PC, McNamara VM, Morgan WE (1997) Goitre: a cause of obstructive sleep apnoea in euthyroid patients. Eur Respir J 10:500–502CrossRefPubMedGoogle Scholar
  3. Grunstein RR, Sullivan CE (1988) Sleep apnea and hypothyroidism: mechanisms and management. Am J Med 85:775–779CrossRefPubMedGoogle Scholar
  4. Hira HS, Sibal L (1999) Sleep apnea syndrome among patients with hypothyroidism. J Assoc Physicians India 47(6):615–618PubMedGoogle Scholar
  5. Jha A, Sharma SK, Tandon N, Lakshmy R, Kadhiravan T, Handa KK, Gupta R, Pandey RM, Chaturvedi PK (2006) Thyroxine replacement therapy reverses sleep-disordered breathing in patients with primary hypothyroidism. Sleep Med 7(1):55–61CrossRefPubMedGoogle Scholar
  6. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMedGoogle Scholar
  7. Kapur VK, Koepsell TD, deMaine J, Hert R, Sandblom RE, Psaty BM (1998) Association of hypothyroidism and obstructive sleep apnea. Am J Respir Crit Care Med 158:1379–1383CrossRefPubMedGoogle Scholar
  8. Kendall-Taylor P, Turnbull DM (1983) Endocrine myopathies. Br Med J 287:705–709CrossRefGoogle Scholar
  9. Lin CC, Tsan KW, Chen PJ (1992) The relationship between sleep apnea syndrome and hypothyroidism. Chest 102:1663–1667CrossRefPubMedGoogle Scholar
  10. Massumi RA, Winnacker JL (1964) Severe depression of the respiratory center in myxedema. Am J Med 36:876–882CrossRefPubMedGoogle Scholar
  11. Millman RP, Bevilacqua J, Peterson DD, Pack AI (1983) Central sleep apnea in hypothyroidism. Am Rev Respir Dis 127:504–507CrossRefPubMedGoogle Scholar
  12. Misiolek M, Marek B, Namyslowski G, Scierski W, Zwirska-Korczala K, Kazmierczak-Zagorska Z, Kajdaniuk D, Misiolek H (2007) Sleep apnea syndrome and snoring in patients with hypothyroidism with relation to overweight. J Physiol Pharmacol 58(Suppl 1):77–85PubMedGoogle Scholar
  13. Orr WC, Males JR, Imes NK (1981) Myxedema and obstructive sleep apnea. Am J Med 70:1061–1066CrossRefPubMedGoogle Scholar
  14. Pelttari L, Rauhala E, Polo O, Hyyppä MT, Kronholm E, Viikari J, Kantola I (1994) Upper airway obstruction in hypothyroidism. J Intern Med 236:177–181CrossRefPubMedGoogle Scholar
  15. Pływaczewski R, Bednarek M, Jonczak L, Zieliński J (2008) Sleep disordered breathing in middle-aped and older Polish urban population. J Sleep Res 17:73–81CrossRefPubMedGoogle Scholar
  16. Rajagopal KR, Abbrecht PH, Derderian SS (1984) Obstructive sleep apnea in hypothyroidism. Ann Intern Med 101:491–494CrossRefPubMedGoogle Scholar
  17. Resta O, Carratu P, Carpagnano GE, Maniscalco M, Di Gioia G, Lacedonia D, Giorgino R, De Pergola G (2005) Influence of subclinical hypothyroidism and T4 treatment on the prevalence and severity of obstructive sleep apnoea syndrome (OSAS). J Endocrinol Invest 28(10):893–898CrossRefPubMedGoogle Scholar
  18. Skatrud J, Iber C, Ewart R, Thomas G, Rasmussen H, Schultze B (1981) Disordered breathing during sleep in hypothyroidism. Am Rev Respir Dis 124:325–329PubMedGoogle Scholar
  19. Winkelman JW, Goldman H, Piscatelli N, Lukas SE, Dorsey CM, Cunningham S (1996) Are thyroid function tests necessary in patients with suspected sleep apnea? Sleep 19(10):790–793PubMedGoogle Scholar
  20. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235CrossRefPubMedGoogle Scholar
  21. Zgliczynska-Widlak J (1998) Chapter 8: Hypothyroidism. In: Zgliczynski S (ed) Thyroid diseases. Elsevier Urban and Partner, Warsaw, pp 126–136 (Textbook in Polish)Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Internal Medicine, Pneumology and AllergologyMedical University of WarsawWarsawPoland

Personalised recommendations