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Acharya H, Jayaraj Mangala S, Kalra P. Evaluating the Spectrum of Sleep Abnormalities in Patients With Primary Hypothyroidism. Cureus 2024; 16:e69855. [PMID: 39435197 PMCID: PMC11493210 DOI: 10.7759/cureus.69855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2024] [Indexed: 10/23/2024] Open
Abstract
Introduction and aim: Primary hypothyroidism is a common endocrine disorder. While thyroid dysfunction is recognized for impacting numerous bodily systems, the connection between thyroid disorders and sleep function remains unclear. Since sleep disorders seldom manifest as the sole presenting symptom of thyroid dysfunction, it is crucial to examine the interplay between thyroid function and sleep when implementing a comprehensive treatment approach for these individuals. This study aimed to assess sleep dysfunction in patients with primary hypothyroidism using validated questionnaires. METHOD This cross-sectional study included 81 participants attending the endocrinology outpatient department. The participants included those with both overt and subclinical primary hypothyroidism who were drug-naive or had a thyroid-stimulating hormone (TSH) level >4.5 µIU/L while on treatment. The study subjects were assessed based on various validated questionnaires for sleep disturbance. RESULTS The study predominantly comprised 64 (79%) female participants. Overall, poor sleepers in subclinical and overt hypothyroidism were 66.7 and 60.8%. The Berlin Risk Score Questionnaire showed the occurrence of sleep apnea to be 26.7% and 27.5% in subclinical and overt groups, respectively. However, the occurrence of sleep dysfunction did not correlate with TSH values alone. CONCLUSION Our findings demonstrate that sleep dysfunction is prevalent in patients with both overt and subclinical primary hypothyroidism. Furthermore, the severity of sleep disruption appears independent of the degree of thyroid dysfunction.
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Affiliation(s)
- Himamshu Acharya
- Endocrinology and Metabolism, MS Ramaiah Medical College, Bengaluru, IND
| | | | - Pramila Kalra
- Endocrinology and Metabolism, MS Ramaiah Medical College, Bengaluru, IND
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Jog A, Mosquera Zavaleta J, Rodriguez Piedra L, Singh A, Fan D, Grbach V, Lvovsky D. Characteristics of Patients Undergoing Bariatric Surgery in an Inner-City Minority Population: A Pre and Postoperative Comparison Between Patients With and Without Obstructive Sleep Apnea. Cureus 2024; 16:e66440. [PMID: 39246910 PMCID: PMC11380468 DOI: 10.7759/cureus.66440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Background Obese patients are at an increased risk of obstructive sleep apnea (OSA). Bariatric surgery or weight loss surgery is an important therapeutic measure in obese patients for the management of weight and comorbidities. Data are scarce in inner-city Hispanic and Black patients who undergo bariatric surgery, which eventually leads to health disparity in this minority population. Differences between patients with and without OSA have not been assessed in this population. This study aims to answer these questions. Methodology The study was conducted in a high-volume hospital in the Bronx, New York. Before bariatric surgery, patients underwent a preoperative evaluation that included a variety of blood tests, a sleep study, esophagogastroduodenoscopy, and echocardiography. They also underwent basic anthropometric measurements, such as weight, height, and body mass index (BMI), before surgery and 6 months and 12 months postoperatively. Additional calculations were made using these anthropometric measures, namely, total weight loss, excess weight loss, and delta BMI. Results Most patients were Hispanic (85.2%), with a mean age of 41.9 ± 10.8 years. We found that of the 108 patients included in the study, 69.4% (70/108) had OSA. Preoperative BMI in the study was 43.9 ± 13 kg/m2. Postoperatively, the mean decrease in BMI was 12.3 ± 14.5 kg/m2. Total weight loss and excess weight loss were 30.2 ± 14.3 and 52.6 ± 16.6, respectively. Conclusions In this study, no significant difference was noted in patients with or without OSA in either the laboratory or anthropometric parameters.
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Affiliation(s)
- Abhishrut Jog
- Pulmonary Medicine, BronxCare Health System, Bronx, USA
| | | | | | - Ajit Singh
- General Surgery, BronxCare Health System, Bronx, USA
| | - David Fan
- General Surgery, BronxCare Health System, Bronx, USA
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3
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Alreshidi NF, Alenzi H, Alrashidi R, Aljaloud LZ, Alshammari AB. The Relationship Between Thyroid Dysfunction and Sleep Quality Among Population of Saudi Arabia. Int J Gen Med 2024; 17:2497-2505. [PMID: 38831928 PMCID: PMC11144793 DOI: 10.2147/ijgm.s462512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Thyroid problems and sleep disturbances are common health problems that impact people of all ages, income levels, and genders. The clinical relationship between these conditions is still not well understood, despite their widespread occurrence. The main objectives of the study were to determine the prevalence of thyroid disorders and evaluate the relationship between them and sleep quality in the Saudi Arabian population. Patients and Methods The study employed an observational cross-sectional design and included a representative Saudi Arabian cohort. The Pittsburgh Sleep Quality Index (PSQI) was included in a digital self-administered survey that participants were asked to complete. Results There were 1044 responders in the study, most of whom (54%) were between the ages of 21 and 30. Female respondents made up 62% of the sample. Thyroid disorders were diagnosed in 9.2% of cases. A significant correlation was found (p=0.001 and p<0.001, respectively) between thyroid disorders and sleep disturbances as well as the use of sleep medications. Conclusion The study revealed a significant prevalence of poor sleep quality in the Saudi population as a whole, with thyroid disorder diagnosis and female gender emerging as independent risk factors. More extensive longitudinal studies in the area are desperately needed.
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Affiliation(s)
- Nahlah Fahad Alreshidi
- Internal Medicine Department, College of Medicine, University of Hail, Hail, Saudi Arabia
| | - Hialah Alenzi
- Internal Medicine Department, College of Medicine, University of Hail, Hail, Saudi Arabia
| | - Rasha Alrashidi
- Internal Medicine Department, College of Medicine, University of Hail, Hail, Saudi Arabia
| | - Luluh Zamil Aljaloud
- Internal Medicine Department, College of Medicine, University of Hail, Hail, Saudi Arabia
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Li Y, Miao Y, Tan J, Zhang Q. Association of modifiable risk factors with obstructive sleep apnea: a Mendelian randomization study. Aging (Albany NY) 2023; 15:14039-14065. [PMID: 38085646 PMCID: PMC10756101 DOI: 10.18632/aging.205288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/16/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The risk factors involved in obstructive sleep apnea (OSA) have not been clearly identified yet. We attempted to systematically investigate genetically predicted modifiable risk factors and lifestyle behaviors associated with OSA. METHODS The association between 34 risk factors and OSA was evaluated using the two-sample Mendelian randomization (MR). Genetic variants for risk factors were acquired from European-descent genome-wide studies. Data sources for OSA were extracted from FinnGen study with 16,761 cases and 201,194 controls. The primary analysis chosen was the inverse-variance weighted method. RESULTS MR analyses provide evidence of genetically predicted poor overall health rating (odds ratio (OR), 2.82; 95% confidence interval (CI), 1.95-4.08), nap during day (OR, 2.01; 95% CI, 1.37-2.93), high body mass index (BMI) (OR, 1.14; 95% CI, 1.09-1.19), increased body fat mass (OR, 1.83; 95% CI, 1.83-2.05), elevated body water mass (OR, 1.50; 95% CI, 1.31-1.70) and hypertension (OR, 1.81; 95% CI, 1.34-2.45) were associated with higher OSA risk, while high education level (OR, 0.55; 95% CI, 0.40-0.75) correlated with reduced OSA risk. Suggestive evidence was obtained for smoking and waist-to-hip ratio (WHR) with higher OSA odds, and vigorous physical activity, and HDL cholesterol with lower OSA odds. After adjusting for BMI using multivariable MR analysis, the effects of smoking, WHR, vigorous physical activity, and HDL-cholesterol were fully attenuated. CONCLUSIONS This MR study indicates that overall health rating, nap during day, BMI, body fat mass, body water mass, hypertension, and education are causally associated with the risk of OSA, which means that these modifiable risk factors are key targets for OSA prevention.
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Affiliation(s)
- Ye Li
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
| | - Yuyang Miao
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
| | - Jin Tan
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
| | - Qiang Zhang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
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Mohammadi I, Adibparsa M, Najafi A, Sehat MS, Sadeghi M. A systematic review with meta-analysis to assess Alzheimer's disease biomarkers in adults with or without obstructive sleep apnoea. Int Orthod 2023; 21:100814. [PMID: 37776696 DOI: 10.1016/j.ortho.2023.100814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION The aim was to design a meta-analysis evaluating the positron emission tomography (PET) uptake and cerebrospinal fluid (CSF), circulating levels of amyloid-β (Aβ), and tau proteins OSA group versus control group, as well as the association of these biomarkers with the severity of OSA. MATERIAL AND METHODS Four databases were searched until April 17, 2023, without any restrictions. The effect sizes were the standardized mean difference (SMD) along with a 95% confidence interval (CI). RESULTS A total of 21 articles were entered into the meta-analysis. The pooled SMDs of the CSF levels in OSA adults compared to controls were: -0.82 (P=0.004) for Aβ42, -1.13 (P<0.001) for Aβ40, 0.17 (P=0.23) for p-tau, 0.04 (P=0.65) for t-tau, 0.08 (P=0.89) for Aβ42/Aβ40 ratio, and 0.81 (P=0.001) for t-tau/Aβ42 ratio. The pooled SMD for the PET uptake of Aβ burden in OSA adults compared to controls was 0.30 (P=0.03). The pooled SMDs of the circulating levels in OSA adults compared to controls were: 0.67 (P=0.002) for Aβ42, 0.11 (P=0.82) for Aβ40, 0.35 (P=0.06) for p-tau, and 1.41(P=0.005) for t-tau. The pooled SMDs for levels of Aβ42, Aβ40, total Aβ, p-tau, t-tau, and Aβ42/Aβ40 ratio in severe OSA adults compared to mild/moderate OSA adults were -0.15 (P=0.33), 0.25 (P=35), 0.04 (P=87), -2.53 (P=0.24), -0.24 (P=0.52), and -0.28 (P=0.30), respectively. CONCLUSIONS The results indicated that CSF levels of Aβ42 and Aβ40 in OSA adults were significantly lower, but the CSF level of t-tau/Aβ42 ratio and PET Aβ burden uptake in OSA adults significantly were higher than in controls.
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Affiliation(s)
- Iman Mohammadi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Mehrdad Adibparsa
- Department of Plastic Surgery, School of Medicine, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Amir Najafi
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Mohammad Soroush Sehat
- Oral and Maxillofacial Surgery Department, School of Dentistry, Isfahan University of Medical Sciences, 81746-73461 Isfahan, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, 67144-15185 Kermanshah, Iran.
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Gencer A, Atahan E, Kadioglu P, Mutlu B. Investigation of the frequency of obstructive sleep apnoea syndrome in patients with subclinical hypothyroidism. ERJ Open Res 2022; 8:00186-2022. [PMID: 36299364 PMCID: PMC9589324 DOI: 10.1183/23120541.00186-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study is to determine the frequency of obstructive sleep apnoea syndrome (OSAS) in a study group with the diagnosis of subclinical hypothyroidism and in a control group without the diagnosis of subclinical hypothyroidism. This study compares these two groups in terms of demographic characteristics, chronic diseases and especially polysomnographic data. Methods A total of 120 patients were included in this study. They consisted of 60 patients with newly diagnosed subclinical hypothyroidism and a control group of 60 patients with normal thyroid functions. Demographic, anthropometric, polysomnography data and Epworth Sleepiness Scale scores of the patients were recorded and compared. Results Any significant difference in the frequency and severity of OSAS was not detected. A significant difference was found in the oxygen desaturation index (ODI), the apnoea-hypopnoea index (AHI) in rapid eye movement sleep, the AHI in supine sleep position and the arousal index of the group experiencing subclinical hypothyroidism with OSAS. Conclusion This study showed that there was no increase in OSAS frequency in patients with subclinical hypothyroidism, but it demonstrated that the ODI and the arousal index were significantly increased in OSAS patients diagnosed with subclinical hypothyroidism. It is thought that the diagnosis and treatment of OSAS in these patients may be important in preventing cardiovascular complications.
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Affiliation(s)
- Aysegul Gencer
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul, Turkey
| | - Ersan Atahan
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul, Turkey
| | - Pinar Kadioglu
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Endocrinology – Diabetes and Metabolism Diseases, Istanbul, Turkey
| | - Birsen Mutlu
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul, Turkey
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Wang L, Fang X, Xu C, Pan N, Wang Y, Xue T, Zhang M, Cao J, Zhang J. Epworth sleepiness scale is associated with hypothyroidism in male patients with obstructive sleep apnea. Front Endocrinol (Lausanne) 2022; 13:1010646. [PMID: 36465644 PMCID: PMC9708720 DOI: 10.3389/fendo.2022.1010646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hypothyroidism could cause obstructive sleep apnea (OSA), however, the specific association of them remained unclear. This cross-sectional study aimed to determine the prevalence of hypothyroidism among patients with OSA, and the characteristics and predictors of hypothyroidism associated with OSA. METHODS A total of 573 patients with OSA were included in the study. Serum levels of thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were measured in all participants. Univariate and binary logistic regression analysis were performed to assess the association of OSA with hypothyroidism while controlling for potential confounders. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the OSA effect in the distinction between euthyroid and hypothyroidism. RESULTS The prevalence of hypothyroidism was 6.75%、5.12%、10.38% in the total, men, and women cohort, respectively, and the prevalence rate in women OSA patients was significantly higher than that in men OSA patients (P=0.018). The men OSA patients with hypothyroidism had a higher Epworth sleepiness scale (ESS) than women OSA patients with hypothyroidism (P=0.022). Additionally, the ESS was significantly higher in men OSA patients with hypothyroidism than those with euthyroid (P=0.042), while women OSA patients had no such difference (P=0.822). In men patients with OSA, ROC curve analyses revealed that the risk of hypothyroidism increased in accordance with increasing ESS after adjustment for potential confounders, and the optimal cutoff value was 10 score. Higher ESS category was significantly associated with a higher risk of prevalent hypothyroidism in men patients with OSA [odds ratio (OR) = 4.898 for ESS≥10 relative to ESS <10, 95% confidence interval (CI) 1.628-14.731, P = 0.005]. CONCLUSIONS The prevalence of hypothyroidism in OSA patients was relatively higher, especially in women OSA patients. ESS was significantly and positively associated with hypothyroidism in men patients with OSA, suggesting that ESS may have a potential role in identification and diagnosis of men OSA patients complicated with hypothyroidism.
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Affiliation(s)
| | | | | | | | | | | | | | - Jie Cao
- *Correspondence: Jie Cao, ; Jing Zhang,
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Yan Y, Li J, Tang H, Wang Y, Zhang W, Liu H, Zhu L, Xiao Z, Yang H, Yu Y. Elevated thyroid-stimulating hormone levels are associated with poor sleep: a cross-sectional and longitudinal study. Endocrine 2022; 75:194-201. [PMID: 34432233 DOI: 10.1007/s12020-021-02849-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Poor sleep accompanied by elevated TSH (thyroid stimulating hormone) levels is not uncommon since TSH secretion is controlled by the circadian rhythm. However, the relationship between poor sleep and TSH elevation is unclear; hence, we aimed to elucidate this relationship by conducting a cross-sectional and longitudinal study. METHODS Participants with isolated elevated (N = 168) and normal (N = 119) TSH concentrations were recruited, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep status. Subjects with an isolated TSH elevation were followed up longitudinally. The serum TSH concentration was remeasured after sleep status improved. RESULTS The proportions of poor sleep and occasional poor sleep in subjects with isolated TSH elevation were significantly higher than those with normal TSH levels (70.24% vs. 49.58%, p = 0.001; 9.52% vs. 1.68%, p = 0.006). Subjects with isolated TSH elevation had significantly higher PSQI scores in the subjective sleep quality, sleep latency, sleep duration, and habitual sleep efficiency dimensions than those with normal TSH levels (all p < 0.05). Poor sleep was significantly associated with isolated TSH elevation in the multiple logistic regression analysis [odds ratio (OR) = 2.396, p = 0.001]. Among subjects with an isolated TSH elevation at baseline, the percentage of TSH normalization was significantly higher in those who slept better than in those who still slept poorly (85.42% vs. 6.45%, p < 0.001). CONCLUSIONS This study revealed that isolated elevated TSH concentrations normalize when the sleep status is improved; hence, we recommend that clinicians thoroughly assess the sleep status of patients and remeasure TSH concentrations after sleep status improves.
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Affiliation(s)
- Yuerong Yan
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, 610041, Chengdu, China
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 510120, Guangzhou, China
| | - Jiaqi Li
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Huairong Tang
- Health Management Center, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Youjuan Wang
- Health Management Center, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Weiwei Zhang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Hui Liu
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Leilei Zhu
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Zhen Xiao
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Hailing Yang
- Graduate Program in Cellular and Molecular Physiology, Graduate School of Biomedical Sciences, Tufts University, Boston, MA, 02111, USA
| | - Yerong Yu
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, 610041, Chengdu, China.
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Wang H, Goodman MO, Sofer T, Redline S. Cutting the fat: advances and challenges in sleep apnoea genetics. Eur Respir J 2021; 57:57/5/2004644. [PMID: 33958377 DOI: 10.1183/13993003.04644-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/10/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Heming Wang
- Division of Sleep and Circadian Disorders, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew O Goodman
- Division of Sleep and Circadian Disorders, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Strausz S, Ruotsalainen S, Ollila HM, Karjalainen J, Kiiskinen T, Reeve M, Kurki M, Mars N, Havulinna AS, Luonsi E, Mansour Aly D, Ahlqvist E, Teder-Laving M, Palta P, Groop L, Mägi R, Mäkitie A, Salomaa V, Bachour A, Tuomi T, Palotie A, Palotie T, Ripatti S. Genetic analysis of obstructive sleep apnoea discovers a strong association with cardiometabolic health. Eur Respir J 2021; 57:13993003.03091-2020. [PMID: 33243845 DOI: 10.1183/13993003.03091-2020] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/04/2020] [Indexed: 12/20/2022]
Abstract
There is currently limited understanding of the genetic aetiology of obstructive sleep apnoea (OSA). We aimed to identify genetic loci associated with OSA risk, and to test if OSA and its comorbidities share a common genetic background.We conducted the first large-scale genome-wide association study of OSA using the FinnGen study (217 955 individuals) with 16 761 OSA patients identified using nationwide health registries.We estimated 0.08 (95% CI 0.06-0.11) heritability and identified five loci associated with OSA (p<5.0×10-8): rs4837016 near GAPVD1 (GTPase activating protein and VPS9 domains 1), rs10928560 near CXCR4 (C-X-C motif chemokine receptor type 4), rs185932673 near CAMK1D (calcium/calmodulin-dependent protein kinase ID) and rs9937053 near FTO (fat mass and obesity-associated protein; a variant previously associated with body mass index (BMI)). In a BMI-adjusted analysis, an association was observed for rs10507084 near RMST/NEDD1 (rhabdomyosarcoma 2 associated transcript/NEDD1 γ-tubulin ring complex targeting factor). We found high genetic correlations between OSA and BMI (rg=0.72 (95% CI 0.62-0.83)), and with comorbidities including hypertension, type 2 diabetes, coronary heart disease, stroke, depression, hypothyroidism, asthma and inflammatory rheumatic disease (rg>0.30). The polygenic risk score for BMI showed 1.98-fold increased OSA risk between the highest and the lowest quintile, and Mendelian randomisation supported a causal relationship between BMI and OSA.Our findings support the causal link between obesity and OSA, and the joint genetic basis between OSA and comorbidities.
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Affiliation(s)
- Satu Strausz
- Dept of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland.,Orthodontics, Dept of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Sanni Ruotsalainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Hanna M Ollila
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Dept of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Juha Karjalainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Depts of Medicine, Neurology and Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Tuomo Kiiskinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mary Reeve
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Mitja Kurki
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Depts of Medicine, Neurology and Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Nina Mars
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Aki S Havulinna
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Elina Luonsi
- Orthodontics, Dept of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Dina Mansour Aly
- Lund University Diabetes Centre, Dept of Clinical Sciences, Lund University, Malmö, Sweden.,Skåne University Hospital, Lund University, Malmö, Sweden
| | - Emma Ahlqvist
- Lund University Diabetes Centre, Dept of Clinical Sciences, Lund University, Malmö, Sweden.,Skåne University Hospital, Lund University, Malmö, Sweden
| | - Maris Teder-Laving
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Priit Palta
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Leif Groop
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Lund University Diabetes Centre, Dept of Clinical Sciences, Lund University, Malmö, Sweden.,Skåne University Hospital, Lund University, Malmö, Sweden
| | - Reedik Mägi
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Antti Mäkitie
- Dept of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Adel Bachour
- Sleep Unit, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Tiinamaija Tuomi
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Lund University Diabetes Centre, Dept of Clinical Sciences, Lund University, Malmö, Sweden.,Skåne University Hospital, Lund University, Malmö, Sweden.,Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Medicine, University of Helsinki and Folkhälsan Research Center, Helsinki, Finland
| | | | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Depts of Medicine, Neurology and Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Tuula Palotie
- Dept of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland.,Orthodontics, Dept of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Dept of Public Health, University of Helsinki, Helsinki, Finland
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11
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Green ME, Bernet V, Cheung J. Thyroid Dysfunction and Sleep Disorders. Front Endocrinol (Lausanne) 2021; 12:725829. [PMID: 34504473 PMCID: PMC8423342 DOI: 10.3389/fendo.2021.725829] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Thyroid disorders and sleep disorders are common problems in the general population that can affect people of all ages, backgrounds, and sexes, but little is known about their clinical associations. We reviewed the literature assessing the associations between thyroid disease and sleep disorders and noted that hyperthyroidism and hypothyroidism have clinical overlap with sleep conditions such as insomnia, restless legs syndrome, and obstructive sleep apnea. These findings highlight the importance of identifying and managing thyroid dysfunction for patients with these common sleep disorders. Additional research is needed to further understand how thyroid dysfunction affects sleep physiology.
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Affiliation(s)
- Max E. Green
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, FL, United States
| | - Victor Bernet
- Division of Endocrinology, Mayo Clinic, Jacksonville, FL, United States
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Joseph Cheung
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL, United States
- *Correspondence: Joseph Cheung,
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12
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Alzahrani AS, Al Mourad M, Hafez K, Almaghamsy AM, Alamri FA, Al Juhani NR, Alhazmi AS, Saeedi MY, Alsefri S, Alzahrani MDA, Al Ali N, Hussein WI, Ismail M, Adel A, El Bahtimy H, Abdelhamid E. Diagnosis and Management of Hypothyroidism in Gulf Cooperation Council (GCC) Countries. Adv Ther 2020; 37:3097-3111. [PMID: 32488658 PMCID: PMC7467410 DOI: 10.1007/s12325-020-01382-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Indexed: 12/15/2022]
Abstract
Hypothyroidism is one of the most common chronic endocrine conditions. However, as symptoms of hypothyroidism are non-specific, up to 60% of those with thyroid dysfunction are unaware of their condition. Left untreated, hypothyroidism may contribute to other chronic health conditions. In the Arabian Gulf States, hypothyroidism is thought to be common, but is underdiagnosed, and management approaches vary. An advisory board of leading Saudi endocrinologists and policy advisers was convened to discuss and formulate recommendations for the diagnosis and management of hypothyroidism in Saudi Arabia based on their clinical expertise. The final document was shared with leading endocrinologists from the other Gulf Cooperation Council (GCC) and aconsensus report was generated and summerized in this article. While there is no consensus regarding population screening of hypothyroidism, current recommendations suggest screening patients with risk factors, including those with a history of head or neck irradiation, a family history of thyroid disease or pharmacological treatment that may affect thyroid function. Evidence from a cross-sectional study in Saudi Arabia suggests screening the elderly (> 60 years), at least in the primary care setting. In Saudi Arabia, the incidence of congenital hypothyroidism is approximately 1 in every 3450 newborns. Saudi nationwide population prevalence data are lacking, but a single-centre study estimated that the prevalence of subclinical hypothyroidism in the primary care setting was 10%. Prevalence rates were higher in other cross-sectional studies exclusively in women (13-35%). The recommendations included in this article aim to streamline the diagnosis and clinical management of hypothyroidism in the GCC, especially in the primary care setting, with the intention of improving treatment outcomes. Further study on the incidence, prevalence and risk factors for, and clinical features of, hypothyroidism in the GCC countries is required.
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Affiliation(s)
- Ali S Alzahrani
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
- Alfaisal University, Riyadh, Saudi Arabia.
| | - Mourad Al Mourad
- Scientific Committee to the General Directorate for Control of Genetic and Chronic Diseases, Assistant Agency for Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kevin Hafez
- Dr Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | | | - Fahad Abdulrahman Alamri
- Director General for Clinical Health Education and Promotion, Ministry of Health, Riyadh, Saudi Arabia
| | - Nasser R Al Juhani
- Department of Internal Medicine, East Jeddah Hospital, Jeddah, Saudi Arabia
| | - Alhussien Sagr Alhazmi
- Department of Obstetrics, Gynaecology and Infertility, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohammad Yahya Saeedi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Director General for Non-Communicable Diseases, Ministry of Health, Riyadh, Saudi Arabia
| | - Saud Alsefri
- Taif University, Taif, Saudi Arabia
- Department of Endocrinology and Diabetes, Al Hada and Taif Armed Forces Hospitals, Taif, Saudi Arabia
| | - Musa Daif Allah Alzahrani
- Unit of Pediatric Endocrinology and Diabetes, Children's Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - Nadia Al Ali
- Unit of Endocrinology and Metabolism, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
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13
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Update on Persistent Excessive Daytime Sleepiness in OSA. Chest 2020; 158:776-786. [PMID: 32147246 DOI: 10.1016/j.chest.2020.02.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/31/2020] [Accepted: 02/22/2020] [Indexed: 12/17/2022] Open
Abstract
OSA is a highly prevalent sleep disorder, and subjective excessive daytime sleepiness (EDS) is the cardinal symptom for which many individuals seek medical advice. Positive airway pressure (PAP) devices, first-line treatment for OSA, eliminates EDS in most patients. However, a subset of patients suffers from persistent EDS despite adherence to therapy. Multiple conditions, some reversible, could account for the residual sleepiness and need to be explored, requiring detailed history, review of PAP data from the smart card, and sometimes additional testing. When all known causes of EDS are excluded, in adequately treated subjects, the purported mechanisms could relate to long-term exposure to the OSA-related sleep fragmentation, sleep deprivation, and hypoxic injury to the arousal system, shifts in melatonin secretion, or altered microbiome. Independent of the mechanism, in well-treated OSA, pharmacological therapy with approved drugs can be considered. Modafinil is commonly prescribed to combat residual EDS, but more recently two drugs, solriamfetol, a dual dopamine-norepinephrine reuptake inhibitor, and pitolisant, a histamine H3 receptor inverse agonist, were approved for EDS. Solriamfetol has undergone randomized controlled trials for treatment of EDS associated with both OSA and narcolepsy, exhibiting robust efficacy. Solriamfetol is renally excreted, with no known drug interactions. Pitolisant, which is nonscheduled, has undergone multiple RCTs in narcolepsy, showing improvement in subjective and objective EDS and one OSA trial showing improvement in subjective EDS.
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14
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Wolters TLC, Roerink SHPP, Drenthen LCA, van Haren-Willems JHGM, Wagenmakers MAEM, Smit JWA, Hermus ARMM, Netea-Maier RT. The Course of Obstructive Sleep Apnea Syndrome in Patients With Acromegaly During Treatment. J Clin Endocrinol Metab 2020; 105:5587082. [PMID: 31612224 PMCID: PMC7705224 DOI: 10.1210/clinem/dgz050] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/25/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is common in active acromegaly and negatively influences quality of life, morbidity, and mortality. This prospective study with 3 predetermined timepoints and a standardized treatment protocol investigates changes in sleep parameters during the first 2.5 years of acromegaly treatment. METHODS Before initiation of acromegaly treatment (medical pretreatment followed by surgery), polysomnography (PSG) was performed in 27 consecutive patients with treatment-naive acromegaly. PSG was repeated after 1 year (N = 24) and 2.5 years (N = 23), and anthropometric and biochemical parameters were obtained. RESULTS At baseline, 74.1% of the patients was diagnosed with OSAS. The respiratory disturbance index (RDI; P = 0.001), oxygen desaturation index (ODI; P = 0.001), lowest oxygen saturation (LSaO2; P = 0.007) and the Epworth Sleepiness Scale (ESS; P < 0.001) improved significantly during treatment, with the greatest improvement in the first year. After 2.5 years of treatment, all patients had controlled acromegaly. Of the 16 patients with repeated PSG and OSAS at baseline, 11 (68.8%) were cured of OSAS. Changes in RDI, ODI, LSaO2, and ESS correlated with insulin-like growth factor 1 levels. CONCLUSION OSAS has a high prevalence in active acromegaly. There is a substantial decrease in prevalence and severity of OSAS following acromegaly treatment, with the largest improvement during the first year. Most patients recover from OSAS following surgical or biochemical control of the acromegaly. Therefore, a PSG is advised after diagnosis of acromegaly. When OSAS is present, it should be treated and PSG should be repeated during acromegaly treatment.
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Affiliation(s)
- Thalijn L C Wolters
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Sean H P P Roerink
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Linda C A Drenthen
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | | | - Margaretha A E M Wagenmakers
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands GD
| | - Johannes W A Smit
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Adrianus R M M Hermus
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
| | - Romana T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands GA
- Correspondence: Romana T. Netea-Maier, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands. E-mail:
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15
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BaHammam AS, Aleissi S, Olaish AH, Almeneessier AS, Jammah AA. Prevalence of Hypothyroidism in a Large Sample of Patients with Obesity Hypoventilation Syndrome. Nat Sci Sleep 2020; 12:649-659. [PMID: 32982523 PMCID: PMC7505711 DOI: 10.2147/nss.s263959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/24/2020] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Data on hypothyroidism in patients with obesity hypoventilation syndrome (OHS) are scarce. This study assessed the prevalence of hypothyroidism among a large group of patients with OHS. PATIENTS AND METHODS This was a prospective observational study of 308 consecutive patients with OHS seen between January 2002 and December 2018. Serum thyroid-stimulating hormone (TSH) and free-thyroxine (FT4) levels were measured in all patients. The OHS patients were compared with 445 patients with obstructive sleep apnoea (OSA) matched for age, sex, and body mass index (BMI). RESULTS The OHS patients had a mean age of 55.1 ± 13.8 years and a BMI of 43.9 ± 14.8 kg/m2; apnoea hypopnea index was ≥30 events/hr in 222 (72%). Clinical hypothyroidism was diagnosed in 58 (18.8%) of the OHS patients; only two cases (0.6%) were diagnosed in the sleep disorders clinic (newly diagnosed cases). Subclinical hypothyroidism was diagnosed in 19 (6.2%) of the OHS patients based on elevated TSH and normal FT4 levels; all cases were newly diagnosed. A logistic regression model identified female sex as the only predictor of clinical hypothyroidism in OHS patients (odds ratio: 2.801 [1.386-5.662], p = 0.004). There was no significant difference in clinical hypothyroidism prevalence between the OHS and OSA patients; however, subclinical hypothyroidism was more common in OHS than in OSA patients (6.2% vs 2.9%, respectively, p = 0.03). CONCLUSION Clinical hypothyroidism was prevalent among patients with OHS; however, newly diagnosed cases of clinical hypothyroidism were relatively low. Female sex was the only predictor of clinical hypothyroidism.
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Affiliation(s)
- Ahmed S BaHammam
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Salih Aleissi
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Awad H Olaish
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aljohara S Almeneessier
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Anwar A Jammah
- Endocrinology Unit, Thyroid Diseases Section, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
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16
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Song L, Lei J, Jiang K, Lei Y, Tang Y, Zhu J, Li Z, Tang H. The Association Between Subclinical Hypothyroidism and Sleep Quality: A Population-Based Study. Risk Manag Healthc Policy 2019; 12:369-374. [PMID: 31908553 PMCID: PMC6927586 DOI: 10.2147/rmhp.s234552] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/05/2019] [Indexed: 02/05/2023] Open
Abstract
Background and Aim The relationship between subclinical hypothyroidism (SHYPO) and sleep quality is still unclear. Our objective was to compare the sleep quality between SHYPO patients and a control group with normal thyroid function. Methods A total of 2224 patients with SHYPO and 12,622 euthyroid (EUTH) control group patients were included in the present study. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The sleep outcomes were compared to explore the association between SHYPO and sleep quality. Furthermore, we tried to identify the risk factors of poor sleep in SHYPO patients. Results Compared to the EUTH control patients, SHYPO patients had a higher PSQI score (6.83 ± 2.67 vs 6.64 ± 2.63, p =0.004) and a higher proportion of poor sleepers (67.09% vs 64.75%, p =0.033). Moreover, subjects with SHYPO were associated with poorer sleep (Odd Ratio (OR) 1.120, 95% Confidence Intervals (CI) 1.016 to 1.235, p =0.023), longer sleep latency (OR 1.162, 95% CI 1.053 to 1.282, p =0.003), and shorter sleep duration (OR 1.148, 95% CI 1.019 to 1.293, p =0.023) after adjusting for potential confounders. Furthermore, we found that lower age, lower body mass index, and women were risk factors for poor sleep quality in SHYPO patients. Conclusion Our findings suggest a relationship between SHYPO and poor sleep quality in a large Chinese population.
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Affiliation(s)
- Linlin Song
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Ke Jiang
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Yali Lei
- Health and Management Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Yuting Tang
- Health and Management Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Jingqiang Zhu
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Huairong Tang
- Health and Management Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
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17
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Thavaraputta S, Dennis JA, Laoveeravat P, Nugent K, Rivas AM. Hypothyroidism and Its Association With Sleep Apnea Among Adults in the United States: NHANES 2007-2008. J Clin Endocrinol Metab 2019; 104:4990-4997. [PMID: 31305928 DOI: 10.1210/jc.2019-01132] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/09/2019] [Indexed: 12/13/2022]
Abstract
CONTEXT The association between hypothyroidism and sleep apnea (SA) has been studied, but results are conflicting and based mostly on small studies. OBJECTIVE To determine whether there is a positive association between hypothyroidism and SA in the US population. DESIGN Cross-sectional study. SETTING US National Health and Nutrition Examination Survey, 2007-2008. PARTICIPANTS We included all subjects ≥18 years old who met inclusion criteria. Participants not on antithyroid medication with a TSH >5.6 mIU/L and those on thyroid hormone replacement regardless of TSH were categorized as hypothyroid. Participants not on thyroid hormone replacement or antithyroid medication who had a TSH ≥0.34 and ≤5.6 mIU/L were categorized as euthyroid. The diagnosis of SA was based on participants' response when asked whether they had been diagnosed with SA by their doctors. MAIN OUTCOME MEASURES Multivariate logistic regression analyses were performed to determine the association between hypothyroidism and SA. RESULTS A total of 5515 adults were included for data analysis. The prevalence of hypothyroidism and hyperthyroidism was calculated at 9.47% and 1.19%, respectively. Multivariate logistic regression analysis adjusted for demographics, health care access, body mass index, socioeconomic factors, alcohol use, smoking, and other comorbidities demonstrated a significant association between hypothyroidism and SA (OR = 1.88, 95% CI, 1.24 to 2.84, P < 0.01). CONCLUSION Hypothyroidism is associated with SA after adjustment for potential confounding variables.
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Affiliation(s)
- Subhanudh Thavaraputta
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Jeff A Dennis
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Passisd Laoveeravat
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Kenneth Nugent
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Ana M Rivas
- Division of Endocrinology, Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
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Chiang KY, Ma TSK, Ip MSM, Lui MMS. Respiratory arrest requiring resuscitation as a rare presentation of obstructive sleep apnoea and hypothyroidism. BMJ Case Rep 2019; 12:12/8/e230163. [DOI: 10.1136/bcr-2019-230163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 79-year-old man, who had significant cardiovascular morbidities, presented with out-of-hospital respiratory arrest. He regained breathing after brief cardiopulmonary resuscitation by his paramedic son. After meticulous investigations, acute cardiovascular events and metabolic causes were ruled out while features of obstructive sleep apnoea were elicited. The findings on in-laboratory polysomnography were compatible with severe obstructive sleep apnoea, with unusually prolonged apnoea duration of up to 2.7 min which most likely accounts for the presentation as ‘respiratory arrest’. Thyroid function test for investigation of his weight gain confirmed hypothyroidism. His symptoms improved gradually after positive airway pressure therapy with bi-level support and thyroxine replacement. On further evaluation, his hypothyroidism is believed to be a complication of long-term amiodarone exposure. The case highlights that the combination of obstructive sleep apnoea and hypothyroidism can lead to catastrophic manifestation and the unusually long apnoea could be a feature prompting further workup for possible hypothyroidism.
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Aldossari K, Al-Ghamdi S, Al-Zahrani J, Al Jammah A, Alanazi B, Al-Briek A, Alanazi M. Association between subclinical hypothyroidism and metabolic disorders: A retrospective chart review study in an emerging university hospital. J Clin Lab Anal 2019; 33:e22983. [PMID: 31325211 PMCID: PMC6868411 DOI: 10.1002/jcla.22983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/06/2022] Open
Abstract
Background Subclinical hypothyroidism is defined as an increase in serum levels of Thyroid Stimulating Hormone (TSH) above the normal range, without alteration of total T4 concentrations that is reported to have association with various metabolic conditions. The study aimed to investigate any association between subclinical hypothyroidism and metabolic disorders in Al Kharj city. Methods This is a cross‐sectional study that included review of patients’ charts from prince Sattam bin Abdul‐Aziz University, Al Kharj, Saudi Arabia, from August 1 to November 30, 2016. Data were analyzed with SPSS version 21. Descriptive statistics were obtained as frequencies. Pearson chi‐square analysis was used to assess any differences between disease status and study variables. P‐value < 0.05 was considered significant. Results The mean age was 30.65 ± 13.3 with a female predominance. The average BMI was 29.5 ± 7.71; 46 (11.5%) had hypertension, 52 (46.8%) had diabetes, 173 (44%) had anemia, and 192 (56%) had vitamin D deficiency. Due to increased TSH levels, male gender had higher prevalence of subclinical hypothyroidism with P‐value < 0.001 and 0.011, respectively. Conclusion Subclinical hypothyroidism is a significant topic worldwide whose prevalence is rising. In this study, we could not find any significant association between subclinical hypothyroidism and metabolic disorder. Further longitudinal studies with large sample size are needed to study this association.
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Affiliation(s)
- Khaled Aldossari
- Department of Family Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Sameer Al-Ghamdi
- Department of Family Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Jamaan Al-Zahrani
- Department of Family Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Anwar Al Jammah
- Department of Endocrinology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Bader Alanazi
- Undergraduate Medical Student, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Abdulilah Al-Briek
- Undergraduate Medical Student, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Mohammad Alanazi
- Undergraduate Medical Student, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
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20
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Madaeva IM, Berdina ON, Semenova NV, Madaev VV, Rychkova LV, Kolesnikova LI. [Obstructive sleep apnea syndrome and age-related hypohonadism]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 117:79-83. [PMID: 28777369 DOI: 10.17116/jnevro20171174279-83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is a common disease that causes a different spectrum of life processes violations in the continuum of 'sleep-wakefulness'. OSAS in combination with age-specific hypogonadism as a systemic pathology requires certain interdisciplinary approaches involving both the correction of the obstruction, and testosterone therapy in men with hypogonadism. AIM Assessment of the effect of combined use of CPAP (Continuous Positive Airway Pressure) and testosterone replacement therapy (transdermal form - Androgel) on indicators of polysomnography monitoring (PSG) with simultaneous study of erectile function and testosterone secretion. MATERIAL AND METHODS 26 men with OSAS and andropause (mean age - 46,1±8,4 years, BMI - 35,2±4,6 kg/m2) were examined. All patients were divided into 2 groups: men with therapy CPAP (n=14); men with combination therapy CPAP and Androgel (50 mg 1 times a day) (n=12). CPAP was carried out by automatic apparatus: Prisma 20A ('Weinemann', Germany) and iSleep 20i ('Breas', Sweden). Duration of therapy in both groups was 2 months. RESULTS There were no statistically significant differences in the baseline characteristics of the physical examination, the level of total testosterone, PSG and nocturnal penile patterns in both groups of patients. After combination therapy (CPAP and Androgel) in men found the increase of total testosterone levels by 2 times (p<0,05) and improvement in indicators of altered nocturnal penile erection episodes (Tup, Tmax, Tm/R, Tup/R, the total number of NPT (p<0,05)) compared with similar parameters in men with only on CPAP-therapy was found. Indicators of the objective status were improved, although there were no changes in PSG characteristics in both groups. CONCLUSION The results of this study indicate greater efficiency of the combined method of treatment (CPAP+Androgel) in patients with OSAS and andropause.
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Affiliation(s)
- I M Madaeva
- Scientific Сentre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - O N Berdina
- Scientific Сentre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - N V Semenova
- Scientific Сentre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - V V Madaev
- Scientific Сentre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - L V Rychkova
- Scientific Сentre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - L I Kolesnikova
- Scientific Сentre for Family Health and Human Reproduction Problems, Irkutsk, Russia
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DOĞAN D, ÖCAL N. Importance and necessity of thyroid function tests in the pre-diagnosis of obstructive sleep apnea. KONURALP TIP DERGISI 2019. [DOI: 10.18521/ktd.375090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Sriphrapradang C, Pinyopodjanard S, Suntornlohanakul O, Nimitphong H, Chirakalwasan N, Saetang S, Anothaisintawee T, Siwasaranond N, Manodpitipong A, Chailurkit LO, Reutrakul S. Lack of associations between thyroid function and obstructive sleep apnea severity in adults with prediabetes and diabetes mellitus. Sleep Breath 2018; 23:963-967. [PMID: 30456738 DOI: 10.1007/s11325-018-1756-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/18/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Hypothyroidism is associated with a high frequency of obstructive sleep apnea (OSA). However, the prevalence of OSA in hypothyroid patients is not different from the general population in many reports. The importance of thyroid function screening in sleep-disordered breathing is still controversial. This study aimed to explore the association between thyroid dysfunction and OSA in the adults with prediabetes or diabetes mellitus type 2, who have very high prevalence of OSA. METHODS OSA was assessed using an in-home monitoring device, WatchPAT200. OSA severity was measured using apnea-hypopnea index (AHI), oxygen desaturation index (ODI), minimum oxygen saturation (minO2), and time spent under oxygen saturation < 90% (T90). Patients with pre-existing thyroid dysfunction were excluded. RESULTS Participants included 70 men and 118 women with mean age 52.8 ± 10.9 years and body mass index 28.2 ± 4.9 kg/m2. One hundred forty participants (75%) had OSA, with a median AHI of 10.1 (interquartile range 4.8, 18.3). The percentage of positive thyroid autoantibody (thyroperoxidase and thyroglobulin antibody) was similar among the subjects with and without OSA. There was no correlation between the levels of thyroid function (TSH, FT3, FT4, TSH/FT3, and TSH/FT4 ratio) and the severity indices of OSA (AHI, ODI, minO2, and T90). CONCLUSIONS These data do not support universal screening for thyroid dysfunction in OSA patients with diabetes or prediabetes.
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Affiliation(s)
- Chutintorn Sriphrapradang
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand.
| | - Sittichai Pinyopodjanard
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Onnicha Suntornlohanakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Hataikarn Nimitphong
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sunee Saetang
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nantaporn Siwasaranond
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Areesa Manodpitipong
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - La-Or Chailurkit
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand
| | - Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Bangkok, 10400, Thailand.,Division of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, IL, USA
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Bruyneel M, Veltri F, Poppe K. Prevalence of newly established thyroid disorders in patients with moderate-to-severe obstructive sleep apnea syndrome. Sleep Breath 2018; 23:567-573. [PMID: 30368659 DOI: 10.1007/s11325-018-1746-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/08/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hypothyroidism can directly cause obstructive sleep apnea (OSA) but may also contribute to it through its impact on the metabolic syndrome. The purpose of this study was to establish the prevalence of known and newly diagnosed overt and subclinical hypothyroidism (SCH) among patients with OSA. METHODS We prospectively included all consecutive moderate or severe OSA patients referred for CPAP therapy. A fasting blood sample was collected to determine thyroid-stimulating hormone (TSH) and free T4 (FT4) levels. RESULTS A total of 280 patients were included (70% male). Mean ± SD body mass index (BMI) and apnea-hypopnea index (AHI) were 33 ± 7 kg/m2 and 49 ± 25, respectively. Median (range) serum TSH levels and mean ± SD FT4 levels were comparable between severe and moderate OSA (1.7 (1.3-2.6) vs 2.1 (1.2-2.8); p = 0.378 and 15.3 ± 2.3 vs 15.3 ± 2.3; p = 0.981). TSH and FT4 levels were not correlated with AHI (p = 0.297 and p = 0.370, respectively), but TSH was correlated with BMI (p = 0.049).Of all patients, 8.9% had increased serum TSH levels (severe and moderate OSA patients had similar levels (p = 0.711)) and 8.2% were newly diagnosed patients (no differences were observed between severe and moderate OSA (p = 0.450)). A total of 16.4% of patients had some type of thyroid disorder. Thyroid function parameters were associated with BMI but not with the severity of OSA. CONCLUSION In our population of moderate or severe OSA, 16% of patients had a thyroid problem and 8% of these were newly diagnosed with SCH.
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Affiliation(s)
- Marie Bruyneel
- Department of Pulmonary Medicine, CHU Saint-Pierre, Rue Haute, 322, 1000, Brussels, Belgium. .,Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Flora Veltri
- Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Endocrinology, CHU Saint-Pierre, Brussels, Belgium
| | - Kris Poppe
- Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Endocrinology, CHU Saint-Pierre, Brussels, Belgium
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Yan YR, Li JQ, Yu YR. Isolated Thyrotropin Elevation is Associated with Insufficient Night-sleep in Night-sleep Restricted Subjects. Chin Med J (Engl) 2017; 130:3001-3002. [PMID: 29237935 PMCID: PMC5742930 DOI: 10.4103/0366-6999.220303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yue-Rong Yan
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Jia-Qi Li
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Ye-Rong Yu
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
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Chung SY, Sylvester MJ, Patel VR, Zaki M, Baredes S, Liu JK, Eloy JA. Impact of obstructive sleep apnea in transsphenoidal pituitary surgery: An analysis of inpatient data. Laryngoscope 2017; 128:1027-1032. [PMID: 28671280 DOI: 10.1002/lary.26731] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/04/2017] [Accepted: 05/16/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Although previous studies have reported increased perioperative complications among obstructive sleep apnea (OSA) patients undergoing any surgery requiring general anesthesia, there is a paucity of literature addressing the impact of OSA on postoperative transsphenoidal surgery (TSS) complications. The aim of this study was to analyze postoperative outcomes in transsphenoidal pituitary surgery patients with OSA. Secondarily, we examined patient characteristics and comorbidities. STUDY DESIGN Retrospective analysis. METHODS The 2002 to 2013 National Inpatient Sample was queried for patients undergoing TSS for pituitary neoplasm. Patients with an additional diagnosis of OSA were identified, and compared to a non-OSA cohort. RESULTS There were 17,777 patients identified; 5.0% (N = 889) had an additional diagnosis of OSA. The OSA cohort had more comorbidities including diabetes mellitus, congestive heart failure, chronic pulmonary disease, coagulopathy, hypertension, hypothyroidism, liver disease, obesity, peripheral vascular disease, renal failure, acromegaly, and Cushing's syndrome. Postoperatively, OSA was independently associated with increased risks of tracheostomy (P = .015) and hypoxemia (P < .001), and decreased risk of cardiac complications (P = .034). OSA patients did not have increased rates of cerebrospinal fluid rhinorrhea, diabetes insipidus, reintubation, aspiration pneumonia, infectious pneumonia, thromboembolic complications, or urinary/renal complications. In-hospital mortality rates did not vary between the two cohorts. CONCLUSIONS In patients who underwent transsphenoidal pituitary surgery, OSA was associated with higher rates of certain pulmonary and airway complications. OSA was not associated with increased non-pulmonary/airway complications or inpatient mortality, despite older average age and higher comorbidity rates. LEVEL OF EVIDENCE 2C. Laryngoscope, 128:1027-1032, 2018.
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Affiliation(s)
- Sei Y Chung
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michael J Sylvester
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Varesh R Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michael Zaki
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Ophthalmology and Visual Science , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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El-Shabrawy M, Elhawary A, Wadea FM. Treatment outcome and predictors of better response to thyroxin in hypothyroid patients with sleep apnea syndrome in Zagazig University hospital. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abnormal thyroid hormones and non-thyroidal illness syndrome in obstructive sleep apnea, and effects of CPAP treatment. Sleep Med 2016; 23:21-25. [PMID: 27692273 DOI: 10.1016/j.sleep.2016.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/08/2016] [Accepted: 07/13/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In obstructive sleep apnea (OSA), while both hypothyroidism and hyperthyroidism have been studied, the occurrence of non-thyroidal illness syndrome (NTIS) (normal thyroid stimulating hormone [TSH] with low triiodotironine) has not been investigated. We explored the occurrence of NTIS in patients with moderate to severe OSA and its relationship to the severity of nocturnal respiratory disorders. We also studied the occurrence of subclinical hypothyroidism (SH, ie, high TSH with normal thyroxine) in OSA and changes in circulating TSH, free triiodotironine (fT3) and free thyroxine (fT4) after CPAP treatment. METHODS After a nocturnal respiratory polysomnography, 125 consecutive patients with moderate to severe OSA and 60 control subjects with normal nocturnal respiration were recruited. Morning circulating TSH, fT3, and fT4 were measured in all subjects. In a subsample of patients, nocturnal polysomnography and hormonal determinations were repeated after CPAP treatment for five months. RESULTS NTIS was found in 13 (10.4%), and SH in ten (8%) OSA subjects, but not in any control subjects. Patients with NTIS showed worse mean nocturnal oxygen saturation and time with saturation <90% (both p < 0.001). After treatment, NTIS subjects (n = 13) showed an increase in fT3 (p < 0.001) to the normal range, and SH subjects (n = 6) a slight decrease in TSH (p = 0.01). In the patients with normal hormones before treatment (n = 45), no change was observed. CONCLUSIONS NTIS may occur in OSA patients with severe nocturnal hypoxemia. OSA treatment is followed by an improvement in TSH in patients with abnormal baseline levels of this hormone, and by recovery of NTIS.
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Abstract
OBJECTIVE This study evaluates the role of hypothyroidism in obstructive sleep apnea (OSA) by comparing the OSA indices in hypothyroid OSA (OSA-HYPOT) with euthyroid OSA (OSA-EUTHY) patients. METHODS After literature search in several electronic databases and selection of studies by following eligibility criteria, meta-analyses of mean differences/standardized mean differences were performed to compare OSA indices at the time of diagnosis between OSA-HYPOT and OSA-EUTHY patients. Metaregression analyses were carried out to examine the relationship between age, BMI, sample size, and gender vs OSA indices in OSA-HYPOT patients. RESULTS Twelve studies and five case reports recruiting 192 OSA-HYPOT and 1423 OSA-EUTHY patients were included in the meta-analysis. Prevalence (mean ± SD) of clinical hypothyroidism in OSA patients was 8.12 ± 7.13% and that of subclinical hypothyroidism 11.07 ± 8.49%. Apnea-Hypopnea Index, time of sleep with oxygen desaturation <90%, and Epworth Sleepiness Scale were significantly higher in the OSA-HYPOT patients at diagnosis, whereas there was no significant difference in arousal index, respiratory disturbance index and sleeping efficiency between OSA-HYPOT and OSA-EUTHY patients. Body mass index was positively associated with Apnea-Hypopnea Index in OSA-HYPOT patients. CONCLUSIONS Hypothyroidism is found to be associated with severity of OSA. However, obesity can be a confounder in the outcomes observed herein.
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Affiliation(s)
- Mingpeng Zhang
- a Department of Geriatrics , Tianjin Medical University General Hospital, Tianjin Geriatrics Institute , Tianjin , China
| | - Weisan Zhang
- a Department of Geriatrics , Tianjin Medical University General Hospital, Tianjin Geriatrics Institute , Tianjin , China
| | - Jin Tan
- a Department of Geriatrics , Tianjin Medical University General Hospital, Tianjin Geriatrics Institute , Tianjin , China
| | - Minghui Zhao
- a Department of Geriatrics , Tianjin Medical University General Hospital, Tianjin Geriatrics Institute , Tianjin , China
| | - Qiang Zhang
- a Department of Geriatrics , Tianjin Medical University General Hospital, Tianjin Geriatrics Institute , Tianjin , China
| | - Ping Lei
- a Department of Geriatrics , Tianjin Medical University General Hospital, Tianjin Geriatrics Institute , Tianjin , China
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Awad SAS, Ashraf EM, Khaled AS, Salih BS, Yousef S, Abeer AS, Anna A. The epidemiology of thyroid diseases in the Arab world: A systematic review. ACTA ACUST UNITED AC 2016. [DOI: 10.5897/jphe2015.0713] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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30
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Li N, Heizhati M, Sun C, Abulikemu S, Shao L, Yao X, Wang Y, Hong J, Zhou L, Wang L, Zhang Y, Zhang W. Thyroid Stimulating Hormone Is Increased in Hypertensive Patients with Obstructive Sleep Apnea. Int J Endocrinol 2016; 2016:4802720. [PMID: 27882050 PMCID: PMC5110875 DOI: 10.1155/2016/4802720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/07/2016] [Accepted: 09/22/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To evaluate alteration in serum TSH in hypertensives with OSA and its relation with cardiometabolic risk factors. Methods. 517 hypertensives were cross-sectionally studied. OSA was determined by polysomnography and thyroid function by standard methods. Results. OSA was diagnosed in 373 hypertensives (72.15%). Prevalence of subclinical hypothyroidism was significantly higher in OSA hypertensives than in non-OSA ones (15.0% versus 6.9%, P = 0.014). Serum LnTSH in hypertensives with severe OSA was significantly higher (0.99 ± 0.81 versus 0.74 ± 0.77 μIU/mL, P < 0.05) than in those without OSA. AHI, LSaO2, ODI3, and ODI4 were independently associated with serum TSH for those aged 30-65 years. Dividing subjects into four groups as TSH < 1.0 μIU/mL, 1.0 ≤ THS ≤ 1.9 μIU/mL, 1.91 ≤ TSH < 4.5 μIU/mL, and TSH ≥ 4.5 μIU/mL, only 26.3% of OSA subjects exhibited TSH between 1.0 and 1.9 μIU/mL, significantly less than non-OSA subjects (26.3% versus 38.2%, P = 0.01). DBP and serum LDL-c elevated with TSH increasing and were only significantly higher in TSH ≥ 4.5 μIU/mL group than in 1.0 ≤ TSH ≤ 1.9 μIU/mL group (96.32 ± 14.19 versus 92.31 ± 12.86 mmHg; P = 0.040; 0.99 ± 0.60 versus 0.87 ± 0.34 mmol/L, P = 0.023). Conclusion. OSA might be a risk factor for increased TSH even within reference range in hypertensive population.
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Affiliation(s)
- Nanfang Li
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
- *Nanfang Li:
| | - Mulalibieke Heizhati
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Chao Sun
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Suofeiya Abulikemu
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Liang Shao
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Xiaoguang Yao
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Yingchun Wang
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Jing Hong
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Ling Zhou
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Lei Wang
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Yu Zhang
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
| | - Weiwei Zhang
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, The Center for Diagnosis, Treatment and Research of Hypertension in Xinjiang, No. 91, TianChi Road, Urumqi, Xinjiang 830001, China
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Comparisons of thyroid hormone, intelligence, attention, and quality of life in children with obstructive sleep apnea hypopnea syndrome before and after endoscopic adenoidectomy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:523716. [PMID: 25654109 PMCID: PMC4310307 DOI: 10.1155/2015/523716] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 12/16/2022]
Abstract
Objective. The aim of this study was to compare the differences in thyroid hormone, intelligence, attention, and quality of life (QoL) of children with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after endoscopic adenoidectomy. Method. A total of 35 OSAHS children (21 males and 14 females with a mean age of 6.81 ± 1.08 years) were included in this study for analyzing the levels of thyroid hormone, intelligence, attention, and QoL. There were 22 children underwent endoscopic adenoidectomy with bilateral tonsillectomy (BT), while the other 13 children who underwent endoscopic adenoidectomy without bilateral tonsillectomy without BT. Results. Our results revealed no significant difference in serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) levels in OSAHS children before and after endoscopic adenoidectomy (all P > 0.05). However, there were significant differences in full-scale intelligence quotient (FIQ) (92.45 ± 5.88 versus 106.23 ± 7.39, P < 0.001), verbal intelligence quotient (VIQ) (94.17 ± 15.01 versus 103.91 ± 9.74, P = 0.006), and performance intelligence quotient (PIQ) (94.12 ± 11.04 versus 104.31 ± 10.05, P = 0.001), attention (98.48 ± 8.74 versus 106.87 ± 8.58, P < 0.001), and total OSA-18 scores (87.62 ± 17.15 versus 46.61 ± 10.15, P < 0.001) between before and after endoscopic adenoidectomy in OSAHS children. Conclusion. Our findings provided evidence that the intelligence, attention, and QoL of OSAHS children may be significantly improved after endoscopic adenoidectomy.
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Abad VC, Guilleminault C. Pharmacological treatment of sleep disorders and its relationship with neuroplasticity. Curr Top Behav Neurosci 2015; 25:503-53. [PMID: 25585962 DOI: 10.1007/7854_2014_365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Sleep and wakefulness are regulated by complex brain circuits located in the brain stem, thalamus, subthalamus, hypothalamus, basal forebrain, and cerebral cortex. Wakefulness and NREM and REM sleep are modulated by the interactions between neurotransmitters that promote arousal and neurotransmitters that promote sleep. Various lines of evidence suggest that sleep disorders may negatively affect neuronal plasticity and cognitive function. Pharmacological treatments may alleviate these effects but may also have adverse side effects by themselves. This chapter discusses the relationship between sleep disorders, pharmacological treatments, and brain plasticity, including the treatment of insomnia, hypersomnias such as narcolepsy, restless legs syndrome (RLS), obstructive sleep apnea (OSA), and parasomnias.
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Affiliation(s)
- Vivien C Abad
- Psychiatry and Behavioral Science-Division of Sleep Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Efficacy of continuous positive airway pressure on testosterone in men with obstructive sleep apnea: a meta-analysis. PLoS One 2014; 9:e115033. [PMID: 25503098 PMCID: PMC4263732 DOI: 10.1371/journal.pone.0115033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of continuous positive airway pressure (CPAP) on serum testosterone in men with obstructive sleep apnea (OSA). METHODS Two reviewers independently searched PubMed, Cochrane library, Embase and Web of Science before June 2014. Information on characteristics of subjects, study design, pre- and post-CPAP treatment of serum total testosterone, free testosterone and sexual hormone blinding protein (SHBG) was extracted for analysis. RESULTS A total of 7 studies with 9 cohorts that included 232 men were pooled into meta-analysis. There was no change of total testosterone levels before and after CPAP treatment in OSA men (standardized mean difference (SMD) = -0.14, 95%CI: -0.63 to 0.34, z = 0.59, p = 0.558), even subdivided by CPAP therapeutic duration (>3 months). Meanwhile, no significant differences in free testosterone and SHBG were detected after CPAP treatment (SMD = 0.16, 95%CI: -0.09 to 0.40, z = 1.25, p = 0.211 and SMD = -0.58, 95%CI: -1.30 to 0.14, z = 1.59, p = 0.112, respectively). CONCLUSION CPAP has no influence on testosterone levels in men with OSA, further large-scale, well-design interventional investigation is needed.
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Takeuchi S, Kitamura T, Ohbuchi T, Koizumi H, Takahashi R, Hohchi N, Suzuki H. Relationship between sleep apnea and thyroid function. Sleep Breath 2014; 19:85-9. [PMID: 24622960 DOI: 10.1007/s11325-014-0966-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/31/2014] [Accepted: 02/24/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Sleep apnea is sometimes associated with hypothyroidism, but the significance of thyroid function screening in sleep apnea patients has been controversial. In the present study, we investigated the relationship between thyroid function and sleep apnea in subjects who were suspected to have sleep apnea. METHODS We enrolled 156 consecutive subjects suspected of having sleep apnea. Subjects included 117 men and 39 women aged 21 to 84 years. They underwent nocturnal multichannel polysomnography during a one-night hospitalization. The examined indices of sleep apnea were apnea-hypopnea index (AHI), lowest oxygen saturation, oxygen desaturation index, longest apnea duration, mean apnea duration, and the percent of apnea time to sleep time. Serum thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were concomitantly measured by electrochemiluminescence immunoassays. RESULTS Three subjects (1.9 %) were diagnosed with primary hypothyroidism (high TSH and low FT4), and one subject (0.6 %) with subclinical hypothyroidism (high TSH and normal FT4). No significant difference in the level of TSH, FT3, or FT4 was seen among subjects with different severity of sleep apnea. The mean apnea duration significantly correlated with TSH in both simple and multiple regression analyses. Subjects with lower FT3 (≤3.75 pg/ml) showed longer mean apnea time compared to those with higher FT3 (>3.75 pg/ml) (24.9 ± 0.8 vs. 20.2 ± 1.2 s; P = 0.009). The other indices of sleep apnea did not show significant correlation with thyroid function. CONCLUSIONS These results suggest that the mean apnea duration and TSH/FT3 may be helpful in understanding reciprocity between the two disease states, and for evaluating the validity of thyroid function tests in patients with sleep apnea.
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Affiliation(s)
- Shoko Takeuchi
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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Ozcan KM, Selcuk A, Ozcan I, Ozdas T, Ozdogan F, Acar M, Dere H. Incidence of hypothyroidism and its correlation with polysomnography findings in obstructive sleep apnea. Eur Arch Otorhinolaryngol 2014; 271:2937-41. [DOI: 10.1007/s00405-014-2962-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
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Hermans MP, Mahadeb YP, Katchunga P, Cikomola Cirhuza J, Ahn SA, Rousseau MF. Novel sexual dimorphisms of sleep apnea syndrome in diabetes. Diabetes Metab Syndr 2014; 8:36-44. [PMID: 24661757 DOI: 10.1016/j.dsx.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND OSAS, a frequently neglected, yet frequent comorbidity in T2DM, is associated with obesity, metabolic syndrome and central fat. OSAS is better documented in males, and this study explored novel gender dimorphisms in T2DM. METHODS Cross-sectional study: 815 T2DM (541 males; 274 females) classified into OSAS[-] and OSAS[+] were assessed for cardiometabolic risk factors, glucose homeostasis, micro/macroangiopathies, CV risk, autoimmune thyroid disease (AITD); and GAD65 antibodies. RESULTS There was a gender dimorphism in glucose control (worse in females), apolipoprotein B100 (higher in females), with apoB100/apoA1 and log(TG)/HDL-C sexually dimorphic. There was also a marked gender dimorphism in GAD65 positivity, higher (+793%) in OSAS[+] females vs. males. There were clear sexual dimorphisms in macro-/microangioathies, regarding stroke, retinopathy and polyneuropathy. OSAS was not sexually dimorphic regarding age; education; and diabetes duration. There was a significant dimorphism in ethnicity. There were no gender-specific dimorphisms related to OSAS in anthropometrics, nor in hypertension, insulin sensitivity, or hyperbolic product loss rate. CONCLUSION We report a series of novel OSAS-related sexual dimorphisms, concerning GAD65 auto-antibodies; polyneuropathy; atherogenic dyslipidemia [all increased in females]; diabetic retinopathy; North-Caucasian ethnicity; metabolic control; and TIA/stroke prevalence [all lower in females]. These findings raise challenging questions regarding the reciprocal pathophysiology between obstructive sleep disorders and cardiometabolic risk in T2DM.
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Affiliation(s)
- Michel P Hermans
- Division of Endocrinology and Nutrition, Université catholique de Louvain, Brussels, Belgium.
| | - Yovan P Mahadeb
- Division of Endocrinology and Nutrition, Université catholique de Louvain, Brussels, Belgium
| | - Philippe Katchunga
- Faculty of Medicine, Catholic University of Bukavu, Democratic Republic of the Congo
| | | | - Sylvie A Ahn
- Division of Cardiology, Université catholique de Louvain, Brussels, Belgium
| | - Michel F Rousseau
- Division of Cardiology, Université catholique de Louvain, Brussels, Belgium
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Affiliation(s)
- Fabio Lanfranco
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy,
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Mete T, Yalcin Y, Berker D, Ciftci B, Guven Firat S, Topaloglu O, Cinar Yavuz H, Guler S. Relationship between obstructive sleep apnea syndrome and thyroid diseases. Endocrine 2013; 44:723-8. [PMID: 23564558 DOI: 10.1007/s12020-013-9927-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) is a widespread disorder characterized by recurrent, partial, or complete episodes of apnea due to upper airway tract obstruction during sleep. OSAS frequency is likely to increase in hypothyroidism because of obesity, macroglossia, dysfunctional upper respiratory tractus (URT) musculature, deposition of mucopolysaccharides in URT tissues, and decreased ventilatory control. This study examines the relationship between OSAS and thyroid disease in OSAS subjects. This study includes 150 polysomnographically diagnosed OSAS patients (50 mild, 50 moderate, 50 severe OSAS cases) treated at Endocrinology and Metabolism Department of Ankara Numune Training and Research Hospital between January 2010 and May 2011 and 32 non-OSAS control subjects. All patients were given serum TSH, free T3 (fT3), free T4 (fT4), anti thyroid peroxidase (Anti-TPO), and anti-thyroglobulin (anti-TG) tests, as well as thyroid ultrasounds. We did not find any difference in prevalence of hypothyroidism, numbers of nodules and parenchyma heterogenicity determined by ultrasound, between OSAS subgroups and controls (p > 0,05). In this study, functional and ultrasonographic examination of the thyroid gland did not reveal any relationship between OSAS and thyroid disease. We believe hence that long-term follow-up studies can establish the possible significance of routine evaluation of OSAS patients for thyroid disease.
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Affiliation(s)
- Turkan Mete
- Department of Endocrinology and Metabolism, Ministry of Health, Ankara Numune Training and Research Hospital, Ankara, Turkey,
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Abstract
BACKGROUND Chronic obstructive pulmonary (COPD) is one of the major causes of morbidity and mortality in the world. COPD is characterized by chronic inflammation in the pulmonary compartment and in the systemic circulation. This disorder is associated with clinically significant alterations in biochemistry and organ function; thyroid dysfunctions are common in chronic diseases, such as COPD. Several characteristics of COPD patients could increase their likelihood of developing hypothyroidism or hyperthyroidism. The purpose of our study was to assess the impact of thyroid dysfunction in patients with COPD. METHODS We evaluated the pulmonary function tests, arterial blood gases, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and thyroid functions in patients with COPD, recruited between admissions in Respiratory Diseases Unit, Policlinico Umberto I, Rome, Italy, from June 2012 to May 2013. We selected patients with subclinical hypothyroidism (ScH), overt hypothyroidism, and hyperthyroidism, and a control group without thyroid disturbance. RESULTS Our results indicate that patients with overt hypothyroidism have lower levels of pO2, MIP, and MEP compared with subjects with ScH, hyperthyroidism, and the control group. We also found a substantial tendency towards pCO2 levels increase in patients with hypothyroidism (p = 0.06). CONCLUSIONS Patients with thyroid dysfunctions have a greater impairment of MIP and MEP and a negative correlation was observed between hypoxemia and TSH. Further studies are needed to investigate whether the treatment of thyroid disfunction could have a beneficial effect on COPD patients' lung function and prognosis.
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Araz O, Ucar EY, Yalcin A, Pulur D, Acemoglu H, Tas H, Saglam L, Akgun M, Mirici A. The incidence and severity of pulmonary hypertension in obstructive sleep apnea with hypothyroidism. Med Sci Monit 2013; 19:883-7. [PMID: 24149072 PMCID: PMC3808256 DOI: 10.12659/msm.889619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 08/13/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Hypothyroidism and obstructive sleep apnea (OSA) are both common health problems and can be seen together. Each of these 2 diseases can cause pulmonary hypertension (PH). We aimed to determine whether hypothyroidism with OSA has a significant effect on the frequency and severity of PH. MATERIAL AND METHODS A total of 236 patients were included in the study. Patients were divided into 3 groups: Group I, Obstructive Sleep Apnea (n=149); Group II, Hypothyroidism (n=56); and Group III, Obstructive Sleep Apnea-Hypothyroidism (n=31). All patients underwent polysomnography and echocardiography and serum levels of thyroid-stimulating hormone (TSH) and free thyroxine 4 (FT4) were analyzed. RESULTS There were 167 male and 69 female participants, and the mean age was 47.8 ± 11.5 (Group I: 81.9% male, 18.1% female; Group II: 44.6% male, 55.4% female; Group III: 64.6% male, 35.4% female). Distribution of mean pulmonary arterial pressure on echocardiography was statistically different among the 3 groups (x(2)=14.99, p=0.006). When adjusted according to the apnea-hypopnea index (AHI), age, and body mass index (BMI), a significant relation with PH was determined (p=0.002). CONCLUSIONS The combination of hypothyroidism with OSA is associated with an increased frequency and severity of PH. When PH is found out of line with the severity of OSA, thyroid dysfunction should be investigated.
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Affiliation(s)
- Omer Araz
- Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - Elif Yilmazel Ucar
- Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - Aslıhan Yalcin
- Department of Pulmonary Diseases, Marmara University, Istanbul, Turkey
| | - Didem Pulur
- Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - Hamit Acemoglu
- Department of Medical Education, Ataturk University School of Medicine, Erzurum, Turkey
| | - Hakan Tas
- Department of Cardiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Leyla Saglam
- Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - Metin Akgun
- Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - Arzu Mirici
- Department of Pulmonary Diseases, 18 Mart University School of Medicine, Canakkale, Turkey
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Aljohani NJ, Al-Daghri NM, Al-Attas OS, Alokail MS, Alkhrafy KM, Al-Othman A, Yakout S, Alkabba AF, Al-Ghamdi AS, Almalki M, Buhary BM, Sabico S. Differences and associations of metabolic and vitamin D status among patients with and without sub-clinical hypothyroid dysfunction. BMC Endocr Disord 2013; 13:31. [PMID: 23962199 PMCID: PMC3751774 DOI: 10.1186/1472-6823-13-31] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/20/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sub-clinical hypothyroid dysfunction, a relatively understudied disorder in the Kingdom of Saudi Arabia (KSA), has significant clinical implications if not properly monitored. Also from KSA, more than 50% of the population suffer from hypovitaminosis D (<50 nmol/l). In this cross-sectional case-control study, we described the differences and associations in the metabolic patterns of adult Saudis with and without hypothyroid dysfunction in relation to their vitamin D status, PTH, calcium and lipid profile. METHODS A total of 94 consenting adult Saudis [52 controls (without subclinical hypothyroidism), 42 cases (previously diagnosed subjects)] were included in this cross-sectional study. Anthropometrics were obtained and fasting blood samples were taken for ascertaining lipid and thyroid profile, as well as measuring PTH, 25(OH) vitamin D and calcium. RESULTS Cases had a significantly higher body mass index than the controls (p < 0.001). Circulating triglycerides was also significantly higher in cases than the controls (p = 0.001). A significant positive association between HDL-cholesterol and PTH (R = 0.56; p = 0.001), as well as a negative and modestly significant negative association between LDL-cholesterol and PTH (R = - 20.0; p = 0.04) were observed. FT3 was inversely associated with circulating 25 (OH) vitamin D (R = -0.25; p = 0.01). CONCLUSIONS Patients with hypothyroid dysfunction possess several cardiometabolic risk factors that include obesity and dyslipidemia. The association between PTH and cholesterol levels as well as the inverse association between vitamin D status and FT3 needs to be reassessed prospectively on a larger scale to confirm these findings.
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Affiliation(s)
- Naji J Aljohani
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
| | - Nasser M Al-Daghri
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
| | - Omar S Al-Attas
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
- Center of Excellence in Biotechnology Research Center, King Saud University, Riyadh, Saudi Arabia
| | - Majed S Alokail
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M Alkhrafy
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Al-Othman
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- College of Applied Medical Sciences, King Saud University, Riyadh, KSA, Saudi Arabia
| | - Sobhy Yakout
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz F Alkabba
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed S Al-Ghamdi
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mussa Almalki
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Badurudeen Mahmood Buhary
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shaun Sabico
- Biochemistry Department, Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
- Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University, Riyadh, Saudi Arabia
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Bowers J, Terrien J, Clerget-Froidevaux MS, Gothié JD, Rozing MP, Westendorp RGJ, van Heemst D, Demeneix BA. Thyroid hormone signaling and homeostasis during aging. Endocr Rev 2013; 34:556-89. [PMID: 23696256 DOI: 10.1210/er.2012-1056] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Studies in humans and in animal models show negative correlations between thyroid hormone (TH) levels and longevity. TH signaling is implicated in maintaining and integrating metabolic homeostasis at multiple levels, notably centrally in the hypothalamus but also in peripheral tissues. The question is thus raised of how TH signaling is modulated during aging in different tissues. Classically, TH actions on mitochondria and heat production are obvious candidates to link negative effects of TH to aging. Mitochondrial effects of excess TH include reactive oxygen species and DNA damage, 2 factors often considered as aging accelerators. Inversely, caloric restriction, which can retard aging from nematodes to primates, causes a rapid reduction of circulating TH, reducing metabolism in birds and mammals. However, many other factors could link TH to aging, and it is these potentially subtler and less explored areas that are highlighted here. For example, effects of TH on membrane composition, inflammatory responses, stem cell renewal and synchronization of physiological responses to light could each contribute to TH regulation of maintenance of homeostasis during aging. We propose the hypothesis that constraints on TH signaling at certain life stages, notably during maturity, are advantageous for optimal aging.
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Affiliation(s)
- J Bowers
- Muséum national d'Histoire Naturelle, Laboratoire de Physiologie Générale et Comparée, Unité Mixte de Recherche, Centre National de la Recherche Scientifique 7221, 75231 Paris cedex 5, France
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Neal JM, Yuhico RJO. "Myxedema madness" associated with newly diagnosed hypothyroidism and obstructive sleep apnea. J Clin Sleep Med 2012; 8:717-8. [PMID: 23243407 DOI: 10.5664/jcsm.2274] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This is the case report of a 32-year-old obese male with a history of agitation, hallucinations, and delirium, recently diagnosed with primary hypothyroidism; he gave a several month history of fatigue with nocturnal snoring and frequent awakening. Polysomnogram revealed severe OSA; initiation of CPAP and levothyroxine resulted in immediate improvement. The lack of a previous psychiatric history and acuteness of presentation was consistent with hypothyroid psychosis complicated by sleep deprivation cause by untreated OSA. Primary hypothyroidism is a common disorder often associated with depression. It is rarely associated with psychosis and was first described as "myxoedematous madness" in 1949. It has not been previously reported to cause psychosis when associated with obstructive sleep apnea. This case illustrates the need for examination of potential multiple organic causes in a patient who presents with psychosis in the critical care setting.
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Affiliation(s)
- J Matthew Neal
- Department of Medicine, Indiana University Health Ball Memorial Hospital, Muncie, IN 47303, USA.
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Andersen ML, Tufik S. Is thyroid screening of sleep clinic patients essential? Sleep Med 2012; 13:1215-6. [DOI: 10.1016/j.sleep.2012.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 09/24/2012] [Indexed: 11/25/2022]
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Schuman CC, Attarian HP. Integrating Sleep Management into Clinical Practice. J Clin Psychol Med Settings 2012; 19:65-76. [DOI: 10.1007/s10880-012-9297-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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