Effects of thyroidectomy on obstructive sleep apnea

Israeli experts performed a literature review with meta-analysis to test the relationship between surgical thyroid removal and obstructive sleep apnea. The results showed that thyroidectomy, in people with obstructive sleep apnea, is associated with small improvements in evidence collected by polysomnography

It has been hypothesized that various thyroid diseases may contribute to the development or course of obstructive sleep apnea. However, it has not been clarified by what mechanisms and what relationships there may be between obstructive sleep apnea on the one hand and, on the other hand, structure and function of the gland and its alterations. The possible positive effect of surgical removal of the thyroid gland on obstructive sleep apnea symptoms has not been defined. For this reason, Masarwy and colleagues performed a systematic literature review of 4 electronic archives of scientific literature, searching for articles that appeared up to February 2022. Specifically, publications were selected in which the variables analyzed before and after thyroidectomy were the apnea and hypopnea index, the Epworth sleepiness scale and the Berlin questionnaire, and the use of CPAP (Continuous Positive Airway Pressure: continuous positive airway pressure), i.e., one of the main treatments of obstructive sleep apnea, was mentioned. A meta-analysis was also performed on the collected data, and risk ratios were calculated. The results of the smaller studies were subjected to a qualitative meta-analysis. The authors selected 6 population-based studies of 221 patients with obstructive sleep apnea who underwent surgical removal of the thyroid gland and used the results for a meta-analysis. The outcomes of the latter showed that thyroidectomy was associated with a significant reduction in the apnea and hypopnea index measured after surgery: mean difference – 6.39; 95% confidence interval – 12.46 to – 0.32. In contrast to the improvement in this index, there were no positive changes in the Berlin questionnaire scores (hazard ratio 0.19; 95% confidence interval 0.03 to 1.17) and the Epworth sleepiness scale (mean difference – 1.04; 95% confidence interval – 6.37 to 4.29). Finally, there was no significant association with CPAP discontinuation: hazard ratio 0.38; 95% confidence interval 0.12 to 1.18.

In the conclusions, the authors pointed out that the meta-analysis demonstrated a slight clinical improvement in obstructive sleep apnea after thyroidectomy. They also pointed out the need for large case-controlled clinical studies with an adequate experimental design and sufficient observation period to better define the effect of thyroidectomy on the course of obstructive sleep apnea.

Source

 The impact of thyroidectomy on obstructive sleep apnea: a systematic review and meta-analysis. European Archives of Oto-Rhino-Laryngology 2022 Jun 20. 

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