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 Table of Contents  
LETTER TO EDITOR
Year : 2014  |  Volume : 1  |  Issue : 4  |  Page : 260

Obstructive sleep apnea: Coexistence with thyroid dysfunction and diabetes mellitus


1 Department of Dentistry, FH Medical College, Tundla, India
2 Department of Prosthodontics and Dental Material Sciences, F.O.D.S., K.G. Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication11-Dec-2014

Correspondence Address:
Varun Baslas
305 Aparna Garden, Vijay Nagar, Agra, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9906.146812

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How to cite this article:
Baslas V, Kaur S, Chand P, Kumar P, Aggarwal H. Obstructive sleep apnea: Coexistence with thyroid dysfunction and diabetes mellitus. J Obes Metab Res 2014;1:260

How to cite this URL:
Baslas V, Kaur S, Chand P, Kumar P, Aggarwal H. Obstructive sleep apnea: Coexistence with thyroid dysfunction and diabetes mellitus. J Obes Metab Res [serial online] 2014 [cited 2021 Jun 20];1:260. Available from: https://www.jomrjournal.org/text.asp?2014/1/4/260/146812

Sir,

I have read the two articles published in the journal (Association of Thyroid Dysfunction and Diabetes Mellitus: Is the Co-Existence Incidental? J Obes Metab Res 2014;1(2):83-84 and Metabolic Syndrome in Hypothyroidism Leading to Type 2 Diabetes Mellitus: A cross-sectional Study of Western Rajasthan J Obes Metab Res 2014;1(2):105-111) with much interest. Both the articles are informative and provide immense knowledge. It is true that thyroid dysfunction, especially hypothyroidism co-exists with type 2 diabetes mellitus (type 2 DM). I would like to add another common disorder, obstructive sleep apnea (OSA) to these metabolic disorders. OSA is a common co-morbidity in people with type 2 DM, with a higher prevalence of 23-86%. [1] Similarly, the prevalence of OSA in hypothyroid patients is estimated to range from 25% to 82%. In a study of 50 patients with primary hypothyroidism, 30% were found to have OSA (apnea-hypopnea index ≥≥5/h). [2] Such an association compels a close attention to OSA as a risk factor.

Both hypothyroidism and OSA share common signs and symptoms. Increased fatigue and sleepiness, decreased cognitive function, decreased libido, obesity and depressed mood are common findings in both disorders. [3] Periorbital edema and pedal edema are other common findings in patients with either disorder. Nevertheless, snoring that is a hallmark of OSA is also reported in hypothyroid cases. [4] The overlap between the two disorders may be a problem for the treating physician in differentiating both disorders. This may result in a misdiagnosis or under-recognition of one or the other disorder. Not infrequently the patients of OSA are mistakenly diagnosed as hypothyroid and given replacement treatment.

Increasing severity of OSA is associated with greater insulin resistance (IR) and suggests that OSA is independently associated with glucose intolerance and worsened glycemic control. [5] Visceral obesity with IR has been traditionally called as metabolic syndrome after the objection from cardiologist in using the term Syndrome X. The addition of OSA to Syndrome X is now labeled as syndrome Z. [6] Thus, IR seems to be the most likely shared pathological mechanism among hypothyroidism, type 2 DM and OSA.

Obstructive sleep apnea activates the sympathetic nervous system and the hypothalamic-pituitary axis. [7] By decreasing this activation via OSA treatment, one might expect short-term improvements even in glycemic control and IR. This would help in type 2 DM and hypothyroidism. Continuous positive airway pressure is the gold standard as a treatment modality in OSA, but due to its low patient compliance, oral appliances are now gaining popularity. Oral appliances have emerged as a successful modality that modifies the position of tongue or jaw, altering the posterior pharyngeal space. The most common oral appliance is Mandibular advancement device, others being tongue retaining and palatal lift appliance. However, despite all these measures locally, there is a need to investigate the inter-relationship of IR, OSA and type 2 DM. This may lead to medical management of OSA.

 
  References Top

1.
Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, et al. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 2009;32:1017-9.  Back to cited text no. 1
    
2.
Jha A, Sharma SK, Tandon N, Lakshmy R, Kadhiravan T, Handa KK, et al. Thyroxine replacement therapy reverses sleep-disordered breathing in patients with primary hypothyroidism. Sleep Med 2006;7:55-61.  Back to cited text no. 2
    
3.
Chan AS, Phillips CL, Cistulli PA. Obstructive sleep apnoea - An update. Intern Med J 2010;40:102-6.  Back to cited text no. 3
    
4.
Georgalas C. The role of the nose in snoring and obstructive sleep apnoea: An update. Eur Arch Otorhinolaryngol 2011;268:1365-73.  Back to cited text no. 4
    
5.
Priou P, Le Vaillant M, Meslier N, Chollet S, Masson P, Humeau MP, et al. Independent association between obstructive sleep apnea severity and glycated hemoglobin in adults without diabetes. Diabetes Care 2012;35:1902-6.  Back to cited text no. 5
    
6.
Parikh RM, Joshi SR. Obstructive sleep apnea and metabolic disorders. Indian J Endocrinol Metab 2006;8:51-2.  Back to cited text no. 6
    
7.
Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol (1985) 2005;99:1998-2007.  Back to cited text no. 7
    




 

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