Source:Sleep Medicine
Author(s): Albino Petrone, Flaminio Mormile, Giacomo Bruni, Michela Quartieri, Maria R. Bonsignore, Oreste Marrone
ObjectiveWhile the influences of both hypothyroidism and hyperthyroidism on obstructive sleep apnea (OSA) 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, i.e. high TSH with normal thyroxine) in OSA and changes in circulating TSH, free triiodotironine (fT3) and free thyroxine (fT4) after CPAP treatment.MethodsAfter 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.ResultsNTIS was found in 13 (10.4%), and SH in 10 (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.ConclusionsNTIS 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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