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Lack of associations between thyroid function and obstructive sleep apnea severity in adults with prediabetes and diabetes mellitus

  • Chutintorn Sriphrapradang
  • Sittichai Pinyopodjanard
  • Onnicha Suntornlohanakul
  • Hataikarn Nimitphong
  • Naricha Chirakalwasan
  • Sunee Saetang
  • Thunyarat Anothaisintawee
  • Nantaporn Siwasaranond
  • Areesa Manodpitipong
  • La-Or Chailurkit
  • Sirimon Reutrakul
Basic Science • Short Communication

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.

Keywords

Hypothyroidism Polysomnography Sleep apnea syndromes Thyrotropin Thyroxine Triiodothyronine 

Notes

Author’s contributions

Study concept and design, manuscript drafting: CS, SP, OS, SR. Data collection: HN, NC, SS, TA, NS, AM, LC, SR. Data interpretation, critical revision of the manuscript, and final approval: all authors.

Funding

This study was supported by the Endocrine Society of Thailand and Mahidol University. Assay for thyroid function and autoantibodies were provided by Roche Diagnostics (Thailand).

Compliance with ethical standards

Competing interests

HN received honoraria from Sanofi, Novo Nordisk, MSD, Takeda, Novartis, Amgen, and AstraZeneca. SR received a grant from MSD and honoraria from Sanofi, Medtronic, Novo Nordisk, and research equipment support from ResMed, Thailand. All other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus JH, Dayan CM, Okosieme OE (2018) Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol 14(5):301–316.  https://doi.org/10.1038/nrendo.2018.18 CrossRefPubMedGoogle Scholar
  2. 2.
    Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3(4):310–318.  https://doi.org/10.1016/S2213-2600(15)00043-0 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Jha A, Sharma SK, Tandon N, Lakshmy R, Kadhiravan T, Handa KK, Gupta R, Pandey RM, Chaturvedi PK (2006) Thyroxine replacement therapy reverses sleep-disordered breathing in patients with primary hypothyroidism. Sleep Med 7(1):55–61.  https://doi.org/10.1016/j.sleep.2005.05.003 CrossRefPubMedGoogle Scholar
  4. 4.
    Winkelman JW, Goldman H, Piscatelli N, Lukas SE, Dorsey CM, Cunningham S (1996) Are thyroid function tests necessary in patients with suspected sleep apnea? Sleep 19(10):790–793CrossRefGoogle Scholar
  5. 5.
    Kapur VK, Koepsell TD, deMaine J, Hert R, Sandblom RE, Psaty BM (1998) Association of hypothyroidism and obstructive sleep apnea. Am J Respir Crit Care Med 158(5 Pt 1):1379–1383.  https://doi.org/10.1164/ajrccm.158.5.9712069 CrossRefPubMedGoogle Scholar
  6. 6.
    Miller CM, Husain AM (2003) Should women with obstructive sleep apnea syndrome be screened for hypothyroidism? Sleep Breath 7(4):185–188.  https://doi.org/10.1007/s11325-003-0185-6 CrossRefPubMedGoogle Scholar
  7. 7.
    Resta O, Pannacciulli N, Di Gioia G, Stefano A, Barbaro MP, De Pergola G (2004) High prevalence of previously unknown subclinical hypothyroidism in obese patients referred to a sleep clinic for sleep disordered breathing. Nutr Metab Cardiovasc Dis 14(5):248–253CrossRefGoogle Scholar
  8. 8.
    Bahammam SA, Sharif MM, Jammah AA, Bahammam AS (2011) Prevalence of thyroid disease in patients with obstructive sleep apnea. Respir Med 105(11):1755–1760.  https://doi.org/10.1016/j.rmed.2011.07.007 CrossRefPubMedGoogle Scholar
  9. 9.
    Reutrakul S, Mokhlesi B (2017) Obstructive sleep apnea and diabetes: a state of the art review. Chest 152(5):1070–1086.  https://doi.org/10.1016/j.chest.2017.05.009 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Sriphrapradang C, Pavarangkoon S, Jongjaroenprasert W, Chailurkit LO, Ongphiphadhanakul B, Aekplakorn W (2014) Reference ranges of serum TSH, FT4 and thyroid autoantibodies in the Thai population: the national health examination survey. Clin Endocrinol 80(5):751–756.  https://doi.org/10.1111/cen.12371 CrossRefGoogle Scholar
  11. 11.
    Mete T, Yalcin Y, Berker D, Ciftci B, Guven Firat S, Topaloglu O, Cinar Yavuz H, Guler S (2013) Relationship between obstructive sleep apnea syndrome and thyroid diseases. Endocrine 44(3):723–728.  https://doi.org/10.1007/s12020-013-9927-9 CrossRefPubMedGoogle Scholar
  12. 12.
    Ozcan KM, Selcuk A, Ozcan I, Ozdas T, Ozdogan F, Acar M, Dere H (2014) Incidence of hypothyroidism and its correlation with polysomnography findings in obstructive sleep apnea. Eur Arch Otorhinolaryngol 271(11):2937–2941.  https://doi.org/10.1007/s00405-014-2962-1 CrossRefPubMedGoogle Scholar
  13. 13.
    Takeuchi S, Kitamura T, Ohbuchi T, Koizumi H, Takahashi R, Hohchi N, Suzuki H (2015) Relationship between sleep apnea and thyroid function. Sleep Breath 19(1):85–89.  https://doi.org/10.1007/s11325-014-0966-0 CrossRefPubMedGoogle Scholar
  14. 14.
    Bozkurt NC, Karbek B, Cakal E, Firat H, Ozbek M, Delibasi T (2012) The association between severity of obstructive sleep apnea and prevalence of Hashimoto's thyroiditis. Endocr J 59(11):981–988CrossRefGoogle Scholar
  15. 15.
    Sorensen JR, Winther KH, Bonnema SJ, Godballe C, Hegedus L (2016) Respiratory manifestations of hypothyroidism: a systematic review. Thyroid 26(11):1519–1527.  https://doi.org/10.1089/thy.2015.0642 CrossRefGoogle Scholar
  16. 16.
    Mickelson SA, Lian T, Rosenthal L (1999) Thyroid testing and thyroid hormone replacement in patients with sleep disordered breathing. Ear Nose Throat J 78(10):768–771 774-765PubMedGoogle Scholar
  17. 17.
    Resta O, Carratu P, Carpagnano GE, Maniscalco M, Di Gioia G, Lacedonia D, Giorgino R, De Pergola G (2005) Influence of subclinical hypothyroidism and T4 treatment on the prevalence and severity of obstructive sleep apnoea syndrome (OSAS). J Endocrinol Investig 28(10):893–898CrossRefGoogle Scholar
  18. 18.
    Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S (2017) 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 27(3):315–389.  https://doi.org/10.1089/thy.2016.0457 CrossRefPubMedGoogle Scholar
  19. 19.
    Kadiyala R, Peter R, Okosieme OE (2010) Thyroid dysfunction in patients with diabetes: clinical implications and screening strategies. Int J Clin Pract 64(8):1130–1139.  https://doi.org/10.1111/j.1742-1241.2010.02376.x CrossRefPubMedGoogle Scholar
  20. 20.
    Attal P, Chanson P (2010) Endocrine aspects of obstructive sleep apnea. J Clin Endocrinol Metab 95(2):483–495.  https://doi.org/10.1210/jc.2009-1912 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Chutintorn Sriphrapradang
    • 1
  • Sittichai Pinyopodjanard
    • 1
  • Onnicha Suntornlohanakul
    • 1
  • Hataikarn Nimitphong
    • 1
  • Naricha Chirakalwasan
    • 2
    • 3
  • Sunee Saetang
    • 1
  • Thunyarat Anothaisintawee
    • 4
  • Nantaporn Siwasaranond
    • 1
  • Areesa Manodpitipong
    • 1
  • La-Or Chailurkit
    • 1
  • Sirimon Reutrakul
    • 1
    • 5
  1. 1.Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
  2. 2.Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
  3. 3.Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand
  4. 4.Department of Family Medicine, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
  5. 5.Division of Endocrinology, Diabetes and MetabolismUniversity of Illinois at ChicagoChicagoUSA

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