Endocrine aspects of obstructive sleep apnea.

CONTEXT

Some endocrine and metabolic disorders are associated with a high frequency of obstructive sleep apnea (OSA), and treatment of the underlying endocrine disorder can improve and occasionally cure OSA. On the other hand, epidemiological and interventional studies suggest that OSA increases the cardiovascular risk, and a link between OSA and glucose metabolism has been suggested, via reduced sleep duration and/or quality.

EVIDENCE ACQUISITION

We reviewed the medical literature for key articles through June 2009.

EVIDENCE SYNTHESIS

Some endocrine and metabolic conditions (obesity, acromegaly, hypothyroidism, polycystic ovary disease, etc.) can be associated with OSA. The pathophysiological mechanisms of OSA in these cases are reviewed. In rare instances, OSA may be improved or even cured by treatment of underlying endocrine disorders: this is the case of hypothyroidism and acromegaly, situations in which OSA is mainly related to upper airways narrowing due to reversible thickening of the pharyngeal walls. However, when irreversible skeletal defects and/or obesity are present, OSA may persist despite treatment of endocrine disorders and may thus require complementary therapy. This is also frequently the case in patients with obesity, even after substantial weight reduction.

CONCLUSIONS

Given the potential neurocognitive consequences and increased cardiovascular risk associated with OSA, specific therapy such as continuous positive airway pressure is recommended if OSA persists despite effective treatment of its potential endocrine and metabolic causes. "Apropos of sleep, that sinister adventure of all our nights, we might say that men go to bed daily with an audacity that would be incomprehensible if we did not know that it is the result of ignorance of the danger." Charles Baudelaire, in "Fusées, IX"