Correction Of Other Medical Disorders

Treatment of hypothyroidism, acromegaly, and nasal congestion may improve the severity of OSA. OSA is common in patients with hypothyroidism, and it is believed that hypothyroidism predisposes to the development of OSA (50). The mechanism for this association may include weight gain, tongue enlargement, muscle dysfunction, and changes in respiratory drive. In patients with sleep apnea, the prevalence of undiagnosed hypothyroidism has been reported in the range of 3.1% to 11.5% (51,52). Whether all patients with OSA should be screened for hypothyroidism is controversial (53). Nevertheless, treatment of hypothyroid-ism may lead to an improvement of OSA (54), and is likely to improve symptoms of daytime fatigue and promote weight loss (55). Treatment of hypothyroidism masquerading as OSA—so called "secondary sleep apnea" may result in resolution of symptoms (56). Having a low threshold for testing thyroid function in patients with OSA is recommended.

Acromegaly is a rare disease characterized by hypersecretion of growth hormone and is associated with an increased prevalence (60-70%) of both obstructive and central sleep apnea (57,58). Sleep apnea likely results from structural abnormalities induced by growth hormone leading to upper airway narrowing, and increased respiratory drive leading to breathing instability due to increased gain of the respiratory controller (59). Treatment with octreotide (Sandostatin®) may lead to improvement of sleep-disordered breathing (60,61). Consequently, appropriate testing for acromegaly should be performed in patients with suggestive clinical findings.

Nasal pathology is associated with OSA (62). This may be related to increased negative pressure in the pharynx during inspiration due to the increased nasal resistance or interference with reflexes designed to protect the patency of the upper airway (63). In patients with concomitant OSA and seasonal allergic rhinitis, use of nasal steroids has been associated with improvement in AHI and nasal airflow resistance (64). Studies looking at the effects of other nasal decongestants have shown limited success in alleviating OSA (65). A study using an external nasal dilator in patients with mild OSA demonstrated a small increase in nocturnal oxygen saturation, but no change in AHI or sleep architecture (66). Surgical repair of nasal pathology has resulted in dramatic improvements of sleep apnea in a small case series (67) though the majority does not seem to derive benefit (68). Regardless, one should examine OSA patients for symptoms and signs of nasal pathology and consider surgical or medical treatment if abnormalities are found. Treatment of nasal pathology may also increase tolerance with CPAP therapy.

Sleep Apnea

Sleep Apnea

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