Obstructive sleep apnea syndrome and hypothyroidism — merely concurrence or causal association?

The prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) ranges from 4 to 7% in men and from 2 to 5% in women. Its deleterious consequences such as traffic accidents, cardiovascular complications increasing morbidity and mortality, make it a major health problem. Apart from obesity (a major risk factor for OSAHS), hypothyroid patients are prone to reveal this phenotype. Although hypothyroidism seems an acknowledged risk factor for OSAHS, some authors report the lack of clinically relevant association. The argument partly depends on the increased prevalence of hypothyroidism in OSAHS patients, but the epidemiological data is limited and somehow inconsistent; even less is known about sub-clinical hypothyroidism in OSAHS patients. Even if frequency of overt and sub-clinical hypothyroidism in OSAHS patients is comparable to the general population, screening for it seems beneficial, as hormone replacement therapy may improve sleep disordered breathing. Unfortunately, this favorable outcome was found only in a few studies with limited number of patients with hypothyroidism. Yet, despite the lack of international guidelines and no large multicentre studies on the topic available, we think that TSH screening might prove beneficial in vast majority of OSAHS patients.The prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) ranges from 4 to 7% in men and from 2 to 5% in women. Its deleterious consequences such as traffic accidents, cardiovascular complications increasing morbidity and mortality, make it a major health problem. Apart from obesity (a major risk factor for OSAHS), hypothyroid patients are prone to reveal this phenotype. Although hypothyroidism seems an acknowledged risk factor for OSAHS, some authors report the lack of clinically relevant association. The argument partly depends on the increased prevalence of hypothyroidism in OSAHS patients, but the epidemiological data is limited and somehow inconsistent; even less is known about sub-clinical hypothyroidism in OSAHS patients. Even if frequency of overt and sub-clinical hypothyroidism in OSAHS patients is comparable to the general population, screening for it seems beneficial, as hormone replacement therapy may improve sleep disordered breathing. Unfortunately, this favorable outcome was found only in a few studies with limited number of patients with hypothyroidism. Yet, despite the lack of international guidelines and no large multicentre studies on the topic available, we think that TSH screening might prove beneficial in vast majority of OSAHS patients

Zespół obturacyjnego bezdechu sennego i niedoczynność tarczycy — przypadkowa zbieżność czy związek przyczynowo-skutkowy?

  Częstość występowania zespołu obturacyjnego bezdechu sennego (OBS) waha się od 4 do 7% u mężczyzn i od 2 do 5% u kobiet. Jest on przyczyną wielu poważnych następstw, takich jak: wypadki drogowe, powikłania sercowo-naczyniowe, a rosnąca zachorowalność i śmiertelność, sprawiają, że staje się jednym z głównych problemów zdrowotnych. Oprócz otyłości (głównego czynnika ryzyka dla OBS) ujawnieniu tego fenotypu sprzyja niedoczynność tarczycy. Mimo że wydaje się ona uznanym czynnikiem ryzyka OBS, niektórzy autorzy sugerują brak klinicznie istotnego związku. Zaobserwowano jednak zwiększoną częstość występowania niedoczynności tarczycy u pacjentów z OBS, ale dane epidemiologiczne są ograniczone. Zdecydowanie mniej wiadomo o subklinicznej niedoczynności tarczycy u pacjentów z OBS. Jeśli jawna i subkliniczna niedoczynność tarczycy w tej grupie pacjentów jest co najmniej tak samo częsta, jak w populacji ogólnej, zasadne wydaje się badanie pacjentów w kierunku niedoczynności tarczycy, ponieważ skuteczne leczenie może zmniejszyć zaburzenia oddychania podczas snu. Niestety, ten korzystny efekt stwierdzono tylko w kilku badaniach na niewielkiej liczbie pacjentów z niedoczynnością tarczycy. Mimo braku międzynarodowych wytycznych oraz dużych, wieloośrodkowych badań, autorzy niniejszej pracy uważają jednak, że przesiewowe badania TSH mogą się okazać korzystne dla sporej grupy pacjentów z OBS.

The role of microRNAs in pathophysiology and diagnostics of metabolic complications in obstructive sleep apnea patients

Obstructive sleep apnea (OSA) is one of the most common sleep disorders, which is characterized by recurrent apneas and/or hypopneas occurring during sleep due to upper airway obstruction. Among a variety of health consequences, OSA patients are particularly susceptible to developing metabolic complications, such as metabolic syndrome and diabetes mellitus type 2. MicroRNAs (miRNAs) as epigenetic modulators are promising particles in both understanding the pathophysiology of OSA and the prediction of OSA complications. This review describes the role of miRNAs in the development of OSA-associated metabolic complications. Moreover, it summarizes the usefulness of miRNAs as biomarkers in predicting the aforementioned OSA complications

Evaluation of HIF-1 Involvement in the BDNF and ProBDNF Signaling Pathways among Obstructive Sleep Apnea Patients

Obstructive Sleep Apnea (OSA) is a chronic condition characterized by intermittent hypoxia associated with multiple comorbidities, including psychiatric disorders, such as depression, insomnia, and cognitive impairment. The brain-derived neurotrophic factor (BDNF) and proBDNF singling pathways have been shown to be involved in this group of diseases. Furthermore, their expression might be affected by hypoxia-inducible factor 1 (HIF-1), which is an oxygen sensitive transcription factor due to its alpha subunit. Therefore, this study aimed to evaluate the association between HIF-1α, BDNF, and proBDNF protein levels among OSA patients. This study included 40 individuals who underwent polysomnography (PSG) and were divided into the OSA group (n = 20; AHI ≥ 30) and healthy control (n = 20; AHI p = 0.023) and the mean SpO2 of desaturations during sleep (ß = −0.577, p = 0.002). This model accounted for 63.3% of the variability in the morning BDNF protein level (F = 14.639, p p = 0.033) and HIF-1α morning protein level (ß = −3.192, p = 0.005). This model accounted for 52.4% of the variability in the morning BDNF protein level (F = 9.355, p = 0.002). The obtained results suggest that the HIF-1 transcription factor might be involved in the pathway activated by proBDNF, which may have protective properties from hypoxia in OSA patients

Zespół obturacyjnego bezdechu sennego i niedoczynność tarczycy—Przypadkowa zbieżność czy związek przyczynowo-skutkowy?

Częstość występowania zespołu obturacyjnego bezdechu sennego (OBS) waha się od 4 do 7% u mężczyzn i od 2 do 5% u kobiet. Jest on przyczyną wielu poważnych następstw, takich jak: wypadki drogowe, powikłania sercowo-naczyniowe, a rosnąca zachorowalność i śmiertelność, sprawiają, że staje się jednym z głównych problemów zdrowotnych. Oprócz otyłości (głównego czynnika ryzyka dla OBS) ujawnieniu tego fenotypu sprzyja niedoczynność tarczycy. Mimo że wydaje się ona uznanym czynnikiem ryzyka OBS, niektórzy autorzy sugerują brak klinicznie istotnego związku. Zaobserwowano jednak zwiększoną częstość występowania niedoczynności tarczycy u pacjentów z OBS, ale dane epidemiologiczne są ograniczone. Zdecydowanie mniej wiadomo o subklinicznej niedoczynności tarczycy u pacjentów z OBS. Jeśli jawna i subkliniczna niedoczynność tarczycy w tej grupie pacjentów jest co najmniej tak samo częsta, jak w populacji ogólnej, zasadne wydaje się badanie pacjentów w kierunku niedoczynności tarczycy, ponieważ skuteczne leczenie może zmniejszyć zaburzenia oddychania podczas snu. Niestety, ten korzystny efekt stwierdzono tylko w kilku badaniach na niewielkiej liczbie pacjentów z niedoczynnością tarczycy. Mimo braku międzynarodowych wytycznych oraz dużych, wieloośrodkowych badań, autorzy niniejszej pracy uważają jednak, że przesiewowe badania TSH mogą się okazać korzystne dla sporej grupy pacjentów z OBS

How to Make the Unpredictable Foreseeable? Effective Forms of Assistance for Children with Autism Spectrum Disorder (ASD) during the COVID-19 Pandemic

Symptomatology in patients with the diagnosis of autism spectrum disorder (ASD) is very heterogeneous. The symptoms they present include communication difficulties, behavior problems, upbringing problems from their parents, and comorbidities (e.g., epilepsy, intellectual disability). A predictable and stable environment and the continuity of therapeutic interactions are crucial in this population. The COVID-19 pandemic has created much concern, and the need for home isolation to limit the spread of the virus has disrupted the functioning routine of children/adolescents with ASD. Are there effective diagnostic and therapeutic alternatives to limit the consequences of disturbing the daily routine of young patients during the unpredictable times of the pandemic? Modern technology and telemedicine have come to the rescue. This narrative review aims to present a change in the impact profile in the era of isolation and assess the directions of changes that specialists may choose when dealing with patients with ASD

Neurotrophins in the Neuropathophysiology, Course, and Complications of Obstructive Sleep Apnea—A Narrative Review

Obstructive sleep apnea (OSA) is a disorder characterized by chronic intermittent hypoxia and sleep fragmentation due to recurring airway collapse during sleep. It is highly prevalent in modern societies, and due to its pleiotropic influence on the organism and numerous sequelae, it burdens patients and physicians. Neurotrophins (NTs), proteins that modulate the functioning and development of the central nervous system, such as brain-derived neurotrophic factor (BDNF), have been associated with OSA, primarily due to their probable involvement in offsetting the decline in cognitive functions which accompanies OSA. However, NTs influence multiple aspects of biological functioning, such as immunity. Thus, extensive evaluation of their role in OSA might enlighten the mechanism behind some of its elusive features, such as the increased risk of developing an immune-mediated disease or the association of OSA with cardiovascular diseases. In this review, we examine the interactions between NTs and OSA and discuss their contribution to OSA pathophysiology, complications, as well as comorbidities

Obstructive Sleep Apnea Syndrome and Hypothyroidism—Merely Concurrence or Causal Association?

The prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) ranges from 4 to 7% in men and from 2 to 5% in women. Its deleterious consequences such as traffic accidents, cardiovascular complications increasing morbidity and mortality, make it a major health problem. Apart from obesity (a major risk factor for OSAHS), hypothyroid patients are prone to reveal this phenotype. Although hypothyroidism seems an acknowledged risk factor for OSAHS, some authors report the lack of clinically relevant association. The argument partly depends on the increased prevalence of hypothyroidism in OSAHS patients, but the epidemiological data is limited and somehow inconsistent; even less is known about sub-clinical hypothyroidism in OSAHS patients. Even if frequency of overt and sub-clinical hypothyroidism in OSAHS patients is comparable to the general population, screening for it seems beneficial, as hormone replacement therapy may improve sleep disordered breathing. Unfortunately, this favorable outcome was found only in a few studies with limited number of patients with hypothyroidism. Yet, despite the lack of international guidelines and no large multicentre studies on the topic available, we think that TSH screening might prove beneficial in vast majority of OSAHS patients

The Role of Brain-Derived Neurotrophic Factor in Immune-Related Diseases: A Narrative Review

Brain-derived neurotrophic factor (BDNF) is a neurotrophin regulating synaptic plasticity, neuronal excitability, and nociception. It seems to be one of the key molecules in interactions between the central nervous system and immune-related diseases, i.e., diseases with an inflammatory background of unknown etiology, such as inflammatory bowel diseases or rheumatoid arthritis. Studies show that BDNF levels might change in the tissues and serum of patients during the course of these conditions, e.g., affecting cell survival and modulating pain severity and signaling pathways involving different neurotransmitters. Immune-related conditions often feature psychiatric comorbidities, such as sleep disorders (e.g., insomnia) and symptoms of depression/anxiety; BDNF may be related as well to them as it seems to exert an influence on sleep structure; studies also show that patients with psychiatric disorders have decreased BDNF levels, which increase after treatment. BDNF also has a vital role in nociception, particularly in chronic pain, hyperalgesia, and allodynia, participating in the formation of central hypersensitization. In this review, we summarize the current knowledge on BDNF’s function in immune-related diseases, sleep, and pain. We also discuss how BDNF is affected by treatment and what consequences these changes might have beyond the nervous system