What endocrine diseases are associated with Obstructive Sleep Apnea?
The endocrine diseases commonly associated with OSA are hypothyroidism , acromegaly , and polycystic ovary syndrome (PCOS), but the most prevalent are obesity and T2DM .
As would be expected, the statistics for these disorders vary, depending on the series.
Although it was once thought that all patients with OSA had subclinical hypothyroidism, this has now been shown not to be the case. In general, 11% to 30% of patients with OSA will have subclinical or overt hypothyroidism, and the prevalence of OSA in patients with hypothyroidism is about 30%.
OSA is reversible in the majority of such patients once they are treated appropriately with thyroid hormone replacement. In one prospective study of nonobese, middle-age men and women with newly diagnosed symptomatic hypothyroidism, 30% had OSA by PSG at study onset; 84% of those subjects had reversal of OSA with TSH normalization.
Finally, insulin levels and measures of glucose tolerance in PCOS are strongly correlated with the risk and severity of OSA.
Additionally, among those PCOS women with normal glucose tolerance, insulin levels are significantly higher in those at high versus low OSA risk, independent of BMI.
Therefore, it is reasonable to assess measures of sleep habits and behaviors, and restorative sleep in all patients with PCOS.
Probably the most alarming statistics are the prevalence of obesity and its partner in crime, T2DM.
Using the older OSA diagnostic criteria, the prevalence of moderate-to-severe OSA in obese women and men age < 65 years, was 4% to 7% and 9% to 14%, respectively.
More recent studies, using current diagnostic definitions, reported a substantially higher prevalence of moderate-to-severe OSA of 23% in obese women and 49% in obese men.