Myxedema and obstructive sleep apnea

Orr, William C.; Males, James L.; Imes, Norman K.

doi:10.1016/0002-9343(81)90867-6

Cited by 130 publications

(39 citation statements)

References 11 publications

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“…Infiltration of upper airway muscles and soft tissues can impair muscle function and reduce the upper airway lumen, as in myxoedema [47], acromegaly [48,49], involvement by neoplastic processes [50], and mucopolysaccharidoses [51], all of which have been associated with a predisposition to OSA. Treatment of the underlying process can reverse upper airway obstruction [47,50].…”

Section: Reduced Upper Airway Calibrementioning

confidence: 99%

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Pathophysiology of obstructive sleep apnoea

Deegan¹,

McNicholas²

1995

Eur Respir J

264

183

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Arousal plays an important role in the termination of each apnoea, but may also contribute to the development of further apnoea, because of a reduction in respiratory drive related to the hypocapnia which results from postapnoeic hyperventilation. A cyclical pattern of repetitive obstructive apnoeas may result.A better understanding of the integrated pathophysiology of OSA should help in the development of new therapeutic techniques.

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Section: Reduced Upper Airway Calibrementioning

confidence: 99%

“…Treatment of the underlying process can reverse upper airway obstruction [47,50]. Most adult patients with OSA, however, have no specific skeletal or soft-tissue lesion obstructing the upper airway, but often have a small congested oropharyngeal airway.…”

Section: Reduced Upper Airway Calibrementioning

confidence: 99%

Pathophysiology of obstructive sleep apnoea

Deegan¹,

McNicholas²

1995

Eur Respir J

264

183

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“…Hypothyroidism is viewed as a risk factor both for obstructive [1][2][3][4][5] and central [6,7] sleep apnoea. Replacement therapy with thyroxine usually leads to amelioration or even cessation of the associated apnoea.…”

mentioning

confidence: 99%

“…Replacement therapy with thyroxine usually leads to amelioration or even cessation of the associated apnoea. Proposed mechanisms linking the two conditions include: narrowing of the upper airway (UA) by deposition of mucopolysaccharides and protein extravasation into the tissues of the face, tongue and pharyngeal structures [1], dysfunction of UA dilator muscles due to hypothyroid myopathy [2,4], or abnormalities of ventilatory control [3,6]. However, little is known about whether an enlarged thyroid gland contributes to sleep-disordered breathing, with only one previous report of an acromegalic patient with obstructive sleep apnoea (OSA) and respiratory failure, who improved after thyroidectomy [7].…”

mentioning

confidence: 99%

Goitre: a cause of obstructive sleep apnoea in euthyroid patients

Deegan¹,

McNamara²,

Morgan³

1997

Eur Respir J

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Goitre: a cause of obstructive sleep apnoea in euthyroid patients. P.C. Deegan, V.M. McNamara, W.E. Morgan. ©ERS Journals 1997. ABSTRACT: While hypothyroidism is considered to predispose to obstructive sleep apnoea (OSA), the presence of a goitre itself is not a recognized cause of OSA.We present the cases of two euthyroid patients with large goitres and clinical evidence of OSA, whose OSA symptoms significantly improved following partial thyroidectomy.This finding suggests that the goitre contributed to their symptoms. Eur Respir J 1997; 10: 500-502 Hypothyroidism is viewed as a risk factor both for obstructive [1][2][3][4][5] and central [6,7] sleep apnoea. Replacement therapy with thyroxine usually leads to amelioration or even cessation of the associated apnoea. Proposed mechanisms linking the two conditions include: narrowing of the upper airway (UA) by deposition of mucopolysaccharides and protein extravasation into the tissues of the face, tongue and pharyngeal structures [1], dysfunction of UA dilator muscles due to hypothyroid myopathy [2,4], or abnormalities of ventilatory control [3,6]. However, little is known about whether an enlarged thyroid gland contributes to sleep-disordered breathing, with only one previous report of an acromegalic patient with obstructive sleep apnoea (OSA) and respiratory failure, who improved after thyroidectomy [7]. We present the cases of two euthyroid patients with large goitres and OSA requiring treatment with nasal continuous positive airway pressure (nCPAP). Case No. 1A 59 year old man, who presented after a gardening accident, was incidentally found to have a deviated trachea on examination and this was confirmed on chest radiography. Clinically, he was euthyroid and had no symptoms of UA obstruction. However, he had biochemical evidence of hyperthyroidism, with an elevated serum thyroxine (T 4 ) of 196 nmol·L -1 (reference range 53-135 nmol·L -1 ) and free T 4 index of 190 (reference range 59-127). A computerized tomographic (CT) scan of the neck and thoracic inlet revealed diffuse enlargement of the thyroid gland, especially of the left lobe, extending upwards to the hyoid arch and retrosternally down to the level of the aortic arch. Prior to surgery, the patient was made euthyroid with carbimazole. However, during follow-up, he reported excessive daytime sleepiness, with heavy snoring, grunting and gasping during sleep. Examination of his UA revealed a deviated nasal septum and a bulky uvula.On overnight oximetry, the patient had a total of 58 dips in arterial oxygen saturation (Sa,O 2 ) of ≥4% (7.4 episodes·h -1 ), the lowest being to 75%, and an obstructed pattern of breathing and heavy snoring on simultaneous video-recording. A diagnosis of clinically significant OSA was made. He had a further sleep study whilst on 7.5 cmH 2 O of nCPAP, with a subjective improvement in sleep quality, abolition of snoring and a reduction in the number of ≥4% dips in Sa,O 2 to a total of 11. After commencing nCPAP at home, he reported that he no longer snored, with more restful ...

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“…The fluid retention in hypothyroidism is known as myxedema. Deposition of hydrophilic mucopolysaccharide and hyaluronic acid in the dermis, tongue, hypopharynx [4] and other interstitial tissues is responsible for this state leading to non pitting edema.…”

Section: Discussionmentioning

confidence: 99%

Myxedema of Upper Airway: A Rare Cause of Stridor

Bidkar¹,

Naik²,

Roshan³

et al. 2013

JCR

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Abstract:Hypothyroidism is known to affect breathing by reducing respiratory drive. Near total narrowing of nasooropharynx and larynx due to myxedema of upper airway in an undiagnosed severe hypothyroidism is a rare phenomenon. We report a case of non goitorous severe hypothyroidism presenting with upper airway obstruction in a 60 year old male-a diagnostic challenge in acute onset airway obstruction. An upper airway myxedema and hypertrophic myopathy of pharyngeal dilator muscles in hypothyroidism can present with severe acute airway compromise in absence of goitorous enlargement of the thyroid gland.

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Myxedema and obstructive sleep apnea

Cited by 130 publications

References 11 publications

Pathophysiology of obstructive sleep apnoea

Pathophysiology of obstructive sleep apnoea

Goitre: a cause of obstructive sleep apnoea in euthyroid patients

Myxedema of Upper Airway: A Rare Cause of Stridor

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