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Cited by 4Thyroid Disorders and TreatmentsSleep and Wakefulness ResearchSleep and related disorders

Comparison of sleep in hypothyroid patients with normal controls

Open access
Sivaprakasam, Kavitha, Ramamoorthy, Shanthimalar·2017·National Journal of Physiology, Pharmacy and Pharmacology
DOI 10.5455/njppp.2017.7.0203427062017
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Abstract

Background: Sleep - A complex amalgam of behavioral and electrophysiological process is maintained by organized interaction between neurons, neural circuits, and neurotransmitters. Hypothyroidism is the inadequate secretion of thyroid hormones by the thyroid gland. Hypothyroidism, the 2nd common endocrine disorder, is often accompanied by complaints of daytime fatigue. This chronic fatigue should be managed as it may result in impaired attention with adverse consequences in the classroom, workplace, not to forget the highways. Aims and Objectives: The primary focus of the present study is to evaluate sleep cycle in newly diagnosed overt hypothyroid patients to investigate if this fatigue is the consequence of sleep disorder. Materials and Method: A total of 30 hypothyroid patients of both sexes underwent polysomnography to assess sleep based on bioelectric potentials - electroencephalogram, electromyogram, and electrooculogram. The results were compared with age- and sex-matched euthyroid controls. Results: Hypothyroid patients showed significant changes in sleep stages when compared with normal euthyroid controls. Although their total sleep time was not significantly altered, Stage I and Stage II sleep was significantly increased (P < 0.001) while deep sleep and rapid eye movement sleep were reduced. Conclusion: This research proves that early diagnosis of hypothyroidism and management guarantees an improvement in sleep quality and productivity in life. [Natl J Physiol Pharm Pharmacol 2017; 7(10.000): 1127-1131]

AI snapshot

Written from the paper’s full text.

TL;DR

In newly diagnosed overt hypothyroid adults, total sleep time was similar to euthyroid controls, but sleep quality was worse, with reduced sleep efficiency and altered sleep-stage distribution. Hypothyroid patients spent more time in light sleep (Stages I and II) and less time in REM sleep.

Key findings

  • Total sleep time did not differ significantly between hypothyroid patients (399 ± 18.68 min) and controls (395 ± 21.20 min).
  • Sleep efficiency was significantly lower in hypothyroid patients (84 ± 7.05%) than controls (92.55 ± 2.17%; P < 0.001).
  • Stage I sleep was significantly longer in hypothyroid patients (43.87 ± 10.88 min vs 21.83 ± 7.22 min; P < 0.001), and Stage II sleep was also increased (222.52 ± 20.25 min vs 207.7 ± 18.45 min; P = 0.004).
  • REM sleep was significantly reduced in hypothyroid patients (60.73 ± 13.92 min vs 85.83 ± 15.95 min; P < 0.001); deep sleep (Stage III/IV) was lower but not statistically significant (table: 72.6 ± 16.93 min vs 80.17 ± 17.51 min, P = 0.09).

Methods

  • Case-control study comparing 30 newly diagnosed overt hypothyroid patients (15 males, 15 females; ages 18–50 years, not on thyroxine replacement) with 30 age- and sex-matched euthyroid controls.
  • Participants underwent full-night polysomnography (6–8 h) using EEG, EOG, and submental EMG; sleep stages were scored using Rechtschaffen and Kales criteria with American Academy of Sleep Medicine updates.
  • Between-group comparisons used Student’s independent t-test, with P < 0.05 considered statistically significant.

Limitations

  • The paper states that the study does not support routine polysomnography for diagnosing sleep disorder in hypothyroid patients, and that its impact might have been improved by studying sleep patterns after hormone replacement therapy.
  • Evident from the text: the sample was small (30 per group), single-center, and limited to newly diagnosed overt hypothyroid patients aged 18–50 years, so findings may not generalize to other hypothyroid populations or treated patients.
  • Evident from the text: Stage III/IV deep sleep values are reported inconsistently between the narrative and Table 1, which limits confidence in that specific result.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.5455/njppp.2017.7.0203427062017

Cites

21 of 21 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 9 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § ABSTRACT · p. 1

    Hypothyroid patients showed significant changes in sleep stages compared with normal euthyroid controls.

    “Hypothyroid patients showed significant changes in sleep stages when compared with normal euthyroid controls.”
    Quote in the paperSubstantial claim
  • Findingown data
    § RESULT · p. 3

    Stage I sleep duration was significantly longer in hypothyroid patients than in euthyroid controls (43.87 ± 10.88 vs 21.83 ± 7.22, P < 0.001).

    “Sleep Stage I of hypothyroid patients was significantly longer 43.87 ± 10.88 (euthyroid 21.83 ± 7.22).”
    • Also stated in: § ABSTRACT · p. 1 · plain
      “Stage I and Stage II sleep was significantly increased ( P < 0.001)”
    Quote in the paperSubstantial claim
  • Findingown data
    § RESULT · p. 3

    Sleep onset latency was significantly decreased in hypothyroid patients compared with euthyroid controls (6.16 ± 2.78 vs 12.60 ± 2.48 min, P < 0.001).

    “The sleep onset latency measured in minutes of hypothyroid patients' 6.16 ± 2.78 shows a significantly decreased P &lt; 0.001 when compared to euthyroid controls 12.60 ± 2.48 (Table 1).”
    Quote in the paperNot a substantial claim
  • Findingown data
    § RESULT · p. 3

    Total sleep time did not differ significantly between hypothyroid patients and euthyroid controls (mean 399 ± 18.68 vs 395 ± 21.20).

    “Total sleep time in both hypothyroid and euthyroid individuals are not statistically significant - the mean value in cases being 399 ± 18.68 and control being 395 ± 21.20.”
    • Also stated in: § ABSTRACT · p. 1 · plain
      “Although their total sleep time was not significantly altered”
    Quote in the paperNot a substantial claim
  • Findingown data
    § RESULT · p. 3

    Stage II sleep duration was significantly increased in hypothyroid patients compared with euthyroid controls (222.52 ± 20.25 vs 207 ± 18.45, P = 0.004).

    “Stage II sleep in hypothyroids was significantly increased 222.52 ± 20.25 (euthyroid 207 ± 18.45).”
    • Also stated in: § DISCUSSION · p. 3 · plain
      “| Stage II (min) | Control | 207.7±18.45 | 0.004* |”
    • Also stated in: § DISCUSSION · p. 3 · plain
      “| Stage II (min) | Cases | 222.52±20.25 | |”
    Quote in the paperNot a substantial claim
  • May combine two claims. 9
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 13

  • May combine two claims.

    Findingown data
    § RESULT · p. 3

    Stage III and IV deep sleep was reduced in hypothyroid patients compared with euthyroid controls, though the difference was not statistically significant.

    “Stage III and IV was reduced in hypothyroid patients 18 ± 3.97 (euthyroid 20.18 ± 3.84) though not significant statistically.”
    • Also stated in: § DISCUSSION · p. 3 · plain
      “| Stage III and IV deep sleep (min) | Control | 80.17±17.51 | 0.09 |”
    • Also stated in: § DISCUSSION · p. 3 · plain
      “| Stage III and IV deep sleep (min) | Cases | 72.6±16.93 | |”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data
    § ABSTRACT · p. 1

    REM sleep was reduced in hypothyroid patients compared with euthyroid controls (60.73 ± 13.92 vs 85.83 ± 15.95 min, P < 0.001).

    “deep sleep and rapid eye movement sleep were reduced.”
    • Also stated in: § DISCUSSION · p. 3 · plain
      “| REM (min) | Control | 85.83±15.95 | <0.001** |”
    • Also stated in: § DISCUSSION · p. 3 · plain
      “| REM (min) | Cases | 60.73±13.92 | |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § MATERIALS AND METHODS · p. 2

    TSH levels were higher in hypothyroid patients than controls (mean 103.02 ± 28.16 vs 2.74 ± 1.03), indicating overt hypothyroidism.

    “The TSH levels had a mean value of 103.02 ± 28.16 in hypothyroid patients. This is of great significance when compared to 2.74 ± 1.03 in controls indicating that the patients belonged to the overt hypothyroid category.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § MATERIALS AND METHODS · p. 2

    The study used 30 age- and sex-matched controls for comparison with the cases.

    “30 age-and sex-matched controls were selected for comparison with the cases.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Pre-study Procedure · p. 2

    Scoring and analysis of recorded data used the sleep scoring criteria of Rechtschaffen and Kales in concordance with American Academy of Sleep Medicine updates.

    “Scoring and analysis of recorded data were done using the sleep scoring criteria of Rechtschaffen and Kales, [12] in concordance with the updates given by the American Academy of Sleep Medicine. [13]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [12] 12. Rechtschaffen A, Kales A. A Manual of Standardised Terminology, Techniques and Scoring for Sleep Stages of Human Subjects. Los Angeles, CA: Brain Information Service/ Brain Research Institute, University of California at ULCA, Los Angeles. Comment: Standard Work for Sleep EEG Scoring; 1968.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [13] 13. Iber C, Ancoli-Israel S, Chesson A, Quan SF. American academy of sleep medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. 1 st ed. Westchester, Illinois: American Academy of Sleep Medicine; 2007.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation
    § MATERIALS AND METHODS · p. 2

    Fasting blood samples were collected to reduce pre-analytical variability and minimize influence caused by food.

    “Fasting blood samples were collected to reduce pre-analytical variability and to minimize influence caused by food. [4]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] 4. Simundic AM, Cornes M, Grankvist K, Lippi G, Nybo M. Standardization of collection requirements for fasting samples: For the working group on preanalytical phase (WG-PA) of the European federation of clinical chemistry and laboratory medicine (EFLM). Clin Chim Acta. 2014;432:33-7. source

  • Classified as probably not a substantial claim.

    Premisecitation
    § Exclusion Criteria · p. 2

    Testosterone reduces total sleep time by direct central nervous system effects by altering serotonergic neurotransmission.

    “Testosterone reduced total sleep time by direct central nervous system effects by altering serotonergic neurotransmission. [6]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] 6. Fink G, Sumner B, Rosie R, Wilson H, McQueen J. Androgen actions on central serotonin neurotransmission: Relevance for mood, mental state and memory. Behav Brain Res. 1999;105(1):53-68. source

  • May combine two claims.

    Interpretationown data
    § CONCLUSION · p. 4

    Decreased thyroid hormone level is detrimental to sleep quality due to frequent arousals, more time in light superficial sleep, and lack of sufficient deep and REM sleep.

    “Decreased thyroid hormone level is detrimental to (sleep quality) quality time spent in sleep due to frequent arousals, more time being spent in light superficial sleep and lack of sufficient deep and REM sleep.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The percentage of sleep Stage I is inversely related to sleep continuity.
    • Rests on an assumption: Deep sleep is necessary for progressive recovery and stabilization of synaptic junctions needed in plastic activities of learning, memory, and consciousness.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § MATERIALS AND METHODS · p. 2

    The study obtained approval from the Institutional Ethical Committee.

    “After obtaining approval of the study from the Institutional Ethical Committee”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Exclusion Criteria · p. 2

    Salt causes disruption in normal sleep pattern.

    “Salt causes disruption in normal sleep pattern.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] 5. Heydarpour F. The effect of salt on night sleep. Endocr Abstr. 2006;11:590.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data
    § Statistical Methodology · p. 3

    The data were analyzed using Student's independent t-test with P < 0.05 taken as statistically significant.

    “The data collected were statistically analyzed using Student's independent t -test to compare the means and standard deviations between the 2 groups. The P &lt; 0.05 was taken as statistically significant.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Exclusion Criteria · p. 2

    Testosterone increases metabolic rate, impairing sleep quality.

    “Testosterone also increased metabolic rate, impairing sleep quality. [7]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § INTRODUCTION · p. 1

    Hypothyroid patients sleep for long periods during the day and when hypothyroidism is severe may lapse into stupor and even coma.

    “Hypothyroid patients sleep for long periods during the day and when hypothyroidism is severe may lapse into stupor and even coma. [3]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] 3. Whybrow PC, Bauer M. Behavioural and psychiatric aspects of hypothyroidism. In: Braverman LE, Utiger RD, editors. The Thyroid. Philadelphia, PA, USA: Lippincott Williams &amp; Wilkins; 2000. p. 837-42.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Exclusion Criteria · p. 2

    Informed verbal and written consent was obtained from the participants.

    “After explanation of the procedure, informed verbal and written consent was obtained from the participants, to PSG was recorded.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § DISCUSSION · p. 3

    The inhibitory effect of sleep on TSH is lost in hypothyroid patients, aggravating the pathology.

    “Therefore, the inhibitory effect of sleep on TSH is lost aggravating the pathology to a greater extent.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given
    § ABSTRACT · p. 1

    Early diagnosis of hypothyroidism and management guarantees an improvement in sleep quality and productivity in life.

    “This research proves that early diagnosis of hypothyroidism and management guarantees an improvement in sleep quality and productivity in life.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning
    § DISCUSSION · p. 4

    This study does not support routine PSG for diagnosing sleep disorder in hypothyroid patients.

    “This study does not support routine PSG - An expensive and time-consuming procedure to diagnose sleep disorder in hypothyroid patients.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: PSG is time-consuming and costly.

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Exclusion Criteria · p. 2

    Participants with conditions and medications that interfere with sleep were excluded from the study.

    “Nightshift workers with irregular sleep routine, diabetes mellitus, hypertension, anemia, renal failure, neurological and psychiatric disorders, substance abuse, gastroesophageal reflux disease, ear, nose, and throat T disorders, and cardiopulmonary disorders were excluded from the study.”
    Quote in the paperSubstantial claim
18 of 18

  • The paper relies on this without support.

    The percentage of sleep Stage I is inversely related to sleep continuity.

    “The percentage of sleep Stage I is inversely related to sleep continuity.”

  • The paper relies on this without support.

    In spite of long sleep periods, hypothyroid patients tend to wake up unrefreshed and remain lethargic throughout the day.

    “In spite of such long sleep period, they tend to wake up unrefreshed and remain lethargic throughout the day.”

  • The paper relies on this without support.

    Deep sleep is necessary for progressive recovery and stabilization of synaptic junctions needed in plastic activities of learning, memory, and consciousness.

    “Deep sleep is necessary for progressive recovery and stabilization of synaptic junctions needed in 'plastic' activities of learning, memory, and consciousness thus establishing sleep's function in neuronal recovery.”

  • The paper relies on this without support.

    PSG is time-consuming and costly.

    “As PSG is time-consuming and costly, effective preclinical diagnostic procedures are needed.”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Control Stage II mean differs between text and table

    Minor

    The results text reports a control Stage II mean of 207 minutes, whereas the table reports 207.7 minutes. The difference exceeds rounding to the whole minute used in the text.

1 of 1

Cites

Flagged first, then by citations

8 of the 29 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. [3]3. Whybrow PC, Bauer M. Behavioural and psychiatric aspects of hypothyroidism. In: Braverman LE, Utiger RD, editors. The Thyroid. Philadelphia, PA, USA: Lippincott Williams &amp; Wilkins; 2000. p. 837-42.
  2. [5]5. Heydarpour F. The effect of salt on night sleep. Endocr Abstr. 2006;11:590.
  3. [22]22. Aserinsky E. The maximal capacity for sleep: Rapid eye movement density as an index of sleep satiety. Biol Psychiatry. 1969;1(2):147-59.
  4. [24]24. Piepenbrink RA, Allenbrand BT, William C. Frey, in Endocrine Secrets. 5 th ed. Philadelphia, PA: Mosby/Elsevier; 2009.
  5. [7]7. Effects of sleep and waking activity. Aviat Space Environ Med. 1996;67(6):513-9.

Cited by

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Related

Authors
Sivaprakasam, K., & Ramamoorthy, S.
Venue
National Journal of Physiology, Pharmacy and Pharmacology
Publisher
ScopeMed
Published
2017
Pages
1
ISSN
  • 2231-3206 (ISSN-L)
  • 2320-4672
DOI
10.5455/njppp.2017.7.0203427062017
OpenAlex
W2734532416
Semantic Scholar
55f0a36a4e7acd5becf42b0c2feece3dd2d18de0
Cited by
4
References
29
Citations by year
2026: 1 · 2025: 2 · 2020: 1
FWCI
0.19
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • National Journal of Physiology Pharmacy and Pharmacology (publishedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
hypothyroidism, sleep architecture, sleep stages, daytime fatigue, polysomnography, REM sleep, slow-wave sleep, thyroid hormones, sleep quality

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