Table of Contents  
COMMENTARY
Year : 2017  |  Volume : 10  |  Issue : 5  |  Page : 467-469  

Obstructive sleep apnea and endocrine disorders


Department of Respiratory Medicine, A. J. Institute of Medical Sciences, Kuntikana, Mangalore, Karnataka, India

Date of Web Publication14-Nov-2017

Correspondence Address:
M Vishnu Sharma
Department of Respiratory Medicine, A. J. Institute of Medical Sciences, Kuntikana, Mangalore, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_17_17

Rights and Permissions

How to cite this article:
Sharma M V. Obstructive sleep apnea and endocrine disorders. Med J DY Patil Univ 2017;10:467-9

How to cite this URL:
Sharma M V. Obstructive sleep apnea and endocrine disorders. Med J DY Patil Univ [serial online] 2017 [cited 2019 Jul 17];10:467-9. Available from: http://www.mjdrdypu.org/text.asp?2017/10/5/467/218178



Obstructive sleep apnea (OSA) leads to a variety of adverse effects on health. Some endocrine and metabolic disorders can be associated with obstructive sleep apnea. Hypothyroidism and acromegaly are the endocrine disorders which can lead to obstructive sleep apnea.[1] Early diagnosis and treatment of the endocrine disorder will lead to a better outcome and may cure OSA in these patients. OSA is associated with increased incidence of polycystic ovary disease (PCOD) and hypogonadism.[1] Treatment of OSA improves these two conditions.

Acromegaly is a relatively rare disease usually due to a benign tumor in the pituitary gland which leads to excess growth hormone secretion. This excess growth hormone leads to overgrowth of soft tissues, bone, and cartilages. Patients with acromegaly can develop OSA. Up to 80% of acromegaly patients can develop OSA.[2] This is due to excess soft tissue, cartilage and bone thickness in the upper airways leading to airway obstruction during sleep. Hence, all patients with acromegaly should be screened for OSA.

Acromegaly increases the risk of cardiovascular diseases. OSA also leads to increased incidence of cardiovascular diseases. Hence, patients with acromegaly with OSA have many fold risks for development of cardiovascular diseases.[3]

Early diagnosis and prompt management of acromegaly may reverse the structural changes in the upper airway and may lead to cure for OSA in these patients. Delayed diagnosis and treatment of acromegaly may lead to permanent changes in the upper airway which may need surgical correction for relieving of OSA symptoms. Some of these patients may need regular continuous positive airway pressure (CPAP) for OSA.[2]

Since acromegaly is not a common endocrine disease, high index of clinical suspicion is essential for diagnosis. All patients with OSA should be examined for the clinical features of acromegaly. Since OSA occurs only when acromegaly is clinically obvious due to skeletal and soft tissue changes, routine screening for acromegaly in OSA patients is not essential. Hence only those with clinical features of acromegaly should undergo further evaluation for OSA.[3]

Symptoms in acromegaly may be headache and visual disturbances due to pituitary tumor. Clinical features include soft tissue swelling and enlargement of extremities, increase in ring and/or shoe size, hyperhidrosis, coarsening of facial features, prognathism, and macroglossia. Thick lips, enlarged nose (particularly a wider nose bridge), protruding jaw, protruding brow, and spaced-out teeth are the characteristic facial features in acromegaly.[4] All clinicians involved in treating OSA patients should be aware and well versed with the clinical features and characteristic facial features of acromegaly so that the condition is not missed.

In the article “Acromegaly presenting as Obstructive Sleep Apnea Syndrome” published in this issue, the authors report a case where the patient presented with features of obstructive sleep apnea which was confirmed by polysomnography. General physical features of the patient aroused the suspicion of acromegaly and further evaluation confirmed the same. The article highlights the importance of being aware of endocrine causes of OSA and also describes the mechanism of OSA in acromegaly.

Unlike acromegaly, hypothyroidism is a relatively common condition. Clinical features of hypothyroidism such as lethargy, weight gain, and excess sleepiness overlap with features of OSA. The prevalence of OSA in hypothyroidism is up to 35%. Hence, all patients with hypothyroidism should be screened for OSA. The main cause for OSA in hypothyroidism is due to narrowing of pharynx due to soft tissue infiltration by mucopolysaccharides and proteins. Hormone replacement therapy for hypothyroidism cures OSA in majority of these patients.

Hypothyroidism is relatively common and there is considerable overlap between symptoms of OSA and hypothyroidism. Hence, all patients with OSA should be tested for hypothyroidism. Treatment of hypothyroidism may cure OSA in these patients.[5] However, a combination of hypothyroidism and OSA may be coincidental, given their high prevalence in the general population.[6]

In some patients, hypogonadism is associated with OSA. This impairment of pituitary-gonadal axis may be due to hypoxia during sleep. In male patients, hypogonadism improves with CPAP therapy for OSA.[7] In female patients, OSA is associated with lower serum estradiol and progesterone suggesting that OSA may also be associated with impaired ovarian function. Proper treatment of OSA improves the ovarian function.[8]

Women with PCOD are found to have increased incidence of OSA.[9] This may be due to obesity and increased visceral fat which predisposes to both the conditions. Hence, all women with PCOD should be screened for OSA.



 
  References Top

1.
Attal P, Chanson P. Endocrine aspects of obstructive sleep apnea. J Clin Endocrinol Metab 2010;95:483-95.  Back to cited text no. 1
[PUBMED]    
2.
Davi' MV, Dalle Carbonare L, Giustina A, Ferrari M, Frigo A, Lo Cascio V, et al. Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease. Eur J Endocrinol 2008;159:533-40.  Back to cited text no. 2
    
3.
Chanson P, Salenave S. Acromegaly. Orphanet J Rare Dis 2008;3:17.  Back to cited text no. 3
[PUBMED]    
4.
Lugo G, Pena L, Cordido F. Clinical manifestations and diagnosis of acromegaly. Int J Endocrinol 2012;2012:10.  Back to cited text no. 4
    
5.
Grunstein RR, Sullivan CE. Sleep apnea and hypothyroidism: Mechanisms and management. Am J Med 1988;85:775-9.  Back to cited text no. 5
[PUBMED]    
6.
Lin CC, Tsan KW, Chen PJ. The relationship between sleep apnea syndrome and hypothyroidism. Chest 1992;102:1663-7.  Back to cited text no. 6
[PUBMED]    
7.
Meston N, Davies RJ, Mullins R, Jenkinson C, Wass JA, Stradling JR. Endocrine effects of nasal continuous positive airway pressure in male patients with obstructive sleep apnoea. J Intern Med 2003;254:447-54.  Back to cited text no. 7
[PUBMED]    
8.
Netzer NC, Eliasson AH, Strohl KP. Women with sleep apnea have lower levels of sex hormones. Sleep Breath 2003;7:25-9.  Back to cited text no. 8
[PUBMED]    
9.
Gateva A, Kamenov Z, Mondeshki TS, Bilyukov R, Georgiev O. Polycystic ovarian syndrome and obstructive sleep apnea. Akush Ginekol (Sofiia) 2013;52:63-8.  Back to cited text no. 9
[PUBMED]    




 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References

 Article Access Statistics
    Viewed904    
    Printed5    
    Emailed0    
    PDF Downloaded101    
    Comments [Add]    

Recommend this journal