Association of Risk of Obstructive Sleep Apnea With Thyroid Eye Disease: Compressive Optic Neuropathy

Abstract

Obstructive sleep apnea and TED have each been independently associated with elevated serologic and tissue inflammatory mediators. The systemic inflammation associated with OSA has been implicated in the pathogenesis of disease states aggravated by untreated OSA. Effective treatment of OSA decreases the levels of circulating inflammatory mediators. Currently, smoking is the only known modifiable risk factor in TED. There is evidence to implicate the pathologic elevation of inflammatory cytokines in the mechanism of smoking on TED. This preliminary investigation reveals a significantly greater prevalence of OSA risk factors among patients with TED-CON, suggesting that this may be another modifiable risk factor associated with TED. Based on screening with the STOP-Bang questionnaire, there is a higher percentage of patients at high risk of OSA with TED with CON than with TED without CON.

Ocular Complications of Obstructive Sleep Apnea

“…The common mechanisms between OSA and hypothyroidism include macroglossia, deposition of mucopolysaccharides in the upper airway, disturbances of upper airway musculature, and suppression of the respiratory center [ 76 ]. With regard to complex inflammatory processes, OSA and TED may share some common circulating cytokines and tissue inflammatory mediators [ 18 , 25 , 71 , 78 ].…”

“…A retrospective study of 109 individuals demonstrated that the prevalence of higher-risk OSA in patients with compressive optic neuropathy from TED was significantly higher than in those without TED-related compressive optic neuropathy [ 78 ]. Another prospective observational cohort study observing 85 patients also revealed that the risk of compressive optic neuropathy and vertical strabismus from TED was significantly higher in patients with a higher risk of OSA [ 79 ].…”

“…Some studies also indicated that CPAP treatment is able to reduce serum levels of systemic inflammatory cytokines [ 19 , 82 ]. Given that smoking is the only known modifiable risk factor in TED, effective treatment of OSA may be another manageable risk factor for TED [ 78 ].…”

“… Bozkurt, 2012 [ 75 ] Turkey 245 OSA patients presented with higher prevalence of Hashimoto’s thyroiditis in conjunction with higher OSA severity, especially among women. Habib, 2019 [ 78 ] USA 109 The prevalence of higher-risk OSA in patients with compressive optic neuropathy from TED was significantly higher than those without TED-related compressive optic neuropathy (59.2% vs. 32.8%, p = 0.006). Godfrey, 2020 [ 79 ] USA 85 A prospective observational cohort study revealed that the risk of compressive optic neuropathy ( p = 0.014) and vertical strabismus ( p = 0.047) from TED was significantly higher in patients with a higher risk of OSA.…”

Teprotumumab and the Evolving Therapeutic Landscape in Thyroid Eye Disease

“…Risk factors include smoking, female sex, age, radioactive iodine treatment, thyroid dysfunction, elevated levels of thyrotropin receptor antibodies, vitamin D deficiency, and potentially hypercholesterolemia ( 6-9 ). In addition, recent studies disclose that diabetes mellitus and obstructive sleep apnea are significantly associated with progression to dysthyroid optic neuropathy (DON) ( 10-12 ).…”