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Cited by 158Obstructive Sleep Apnea ResearchThyroid Disorders and TreatmentsNeuroscience of respiration and sleep

Sleep apnea and hypothyroidism: mechanisms and management

Grunstein, Ronald R., Sullivan, Colin E.·1988·The American Journal of Medicine
DOI 10.1016/s0002-9343(88)80020-2
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Abstract

Purpose There is a high incidence of sleep apnea in patients with untreated hypothyroidism. Thyroxine treatment is said to significantly reduce the apnea index and length and sleep apnea symptoms. We undertook a review of 10 consecutive hypothyroid patients with sleep apnea to investigate mechanisms and management of these two disorders. Patients and methods Polysomnograms were obtained in 10 consecutive hypothyroid patients referred to our sleep disorders unit. All patients were studied while hypothyroid. Eight patients were restudied later when euthyroid. Lung function, blood gas values, and awake supraglottic resistance were also assessed in each patient. Results All 10 patients had sleep apnea and were treated with thyroxine. In one patient, hypothyroid myopathy involving the upper airway was demonstrated to be a potential mechanism of sleep apnea in hypothyroidism. Nocturnal angina and ventricular arrhythmias developed in two patients, despite the use of low thyroxine doses. Nasal continuous positive airways pressure (CPAP) was begun in eight patients. Initiation of CPAP prevented further angina or arrythmia in the patients with these cardiac complications. Six of the eight patients who were available for follow-up studies had persistent sleep apnea despite an euthyroid status (apnea index before thyroxine, 51 +/- 6; apnea index after thyroxine, 45 +/- 8), and CPAP therapy was continued in these patients. Conclusion Our experience suggests that the apnea index does not decrease significantly in all patients with hypothyroidism and sleep apnea when euthyroidism is achieved. Treatment of hypothyroidism in the presence of sleep apnea is potentially hazardous and may lead to cardiovascular complications. Management by a combination of CPAP and low-dose thyroxine is helpful in this situation.

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Crossref · 10.1016/s0002-9343(88)80020-2

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  • The increased prevalence of OSAS appears to be related to obesity and male sex rather than to hypothyroidism per se.

    “The increased prevalence of OSAS appears to be related to obesity and male sex rather than to hypothyroidism per se, although decreased ventilatory responses, extravasation of albumin, and mucopolysaccharides in the tissues of the upper airway and hypothyroid myopathy have been suggested as possible contributing factors for OSAS in hypothyroidism [3].”

    From Sleep apnea syndrome and hypothyroidism (2013) · cites this paper as [3]

  • A link between hypothyroidism and OSAS is suggested by the high prevalence of sleep apnea among hypothyroid patients, particularly in rare myxedematous cases.

    “A link between hypothyroidism and OSAS is suggested by the high prevalence of sleep apnea among hypothyroid patients, particularly in rare myxedematous cases [3,7].”

    From Sleep apnea syndrome and hypothyroidism (2013) · cites this paper as [3]

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  1. Hodges, 1983, Increase in pharyngeal resistance during sleep in normal man, Am Rev Respir Dis, 127, 235

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Authors
Grunstein, R. R., & Sullivan, C. E.
Affiliations
The University of Sydney (AU)
Corresponding author
Grunstein, Ronald R.
ORCID
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
1988-12
Volume
85
Issue
6
Pages
775-779
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/s0002-9343(88)80020-2
OpenAlex
W2165245395
Semantic Scholar
4ac030b1d66b1dd5bd122b3890992aa493da2448
Cited by
158
References
21
Citations by year
2025: 5 · 2023: 1 · 2022: 6 · 2021: 2 · 2020: 3 · 2019: 2 · 2018: 4 · 2017: 3 · 2016: 12 · 2015: 7 · 2014: 4 · 2013: 6 · 2012: 3
FWCI
1.40
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Keywords
sleep apnea, hypothyroidism, thyroxine therapy, continuous positive airway pressure, apnea index, hypothyroid myopathy, upper airway resistance, nocturnal angina, ventricular arrhythmias, cardiovascular complications, euthyroidism
MeSH terms
Aged, Female, Humans, Hypothyroidism, Male, Middle Aged, Positive-Pressure Respiration, Respiratory Function Tests, Sleep Apnea Syndromes, Thyroxine

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