Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Italy; Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Via S. Maugeri 4, Pavia 27100, Italy.
Unit of Respiratory Function and Sleep Medicine, Istituti Clinici Scientifici Maugeri IRCCS, Pavia 27100, Italy.
Eur J Intern Med. 2024 Aug;126:49-55. doi: 10.1016/j.ejim.2024.03.013. Epub 2024 Mar 28.
The relationship between subclinical hypothyroidism (SHYPO) and sleep disturbances is still poorly investigated. This systematic review aims to critically appraise the existing literature to provide more insights in understanding whether SHYPO favors sleep disturbances or it is the sleep disturbance per se that affects the hypothalamus-pituitary-thyroid axis regulation.
Original studies on sleep quality and duration in patients with SHYPO were searched in the PubMed/MEDLINE, Embase, Web of Science and Scopus databases. Two reviewers independently screened articles for inclusion, extracted data, and assessed the quality of included studies.
Eight studies, including 2916 patients with SHYPO and 18,574 healthy controls, were retrieved. An overall agreement (7 out of 8 studies), about a positive correlation between decreased sleep quality and/or duration and SHYPO was observed. Five studies investigated sleep quality through self-reported surveys; only two studies explored both subjective and objective assessment of sleep quality with actigraphy (n = 1) or polysomnography (n = 1); finally, one study assessed subjective evaluation of sleep quality through a single question regarding the number of sleeping hours. A high level of heterogeneity among studies was manifest due to differences in population source, sleep measure assessment and criteria for diagnosing SHYPO.
Overall, the existing literature data suggest a link between SHYPO and sleep disturbances, but further studies on larger populations of patients with homogeneous study designs and outcomes are warranted.
亚临床甲状腺功能减退症（SHYPO）与睡眠障碍之间的关系仍未得到充分研究。本系统评价旨在批判性地评估现有文献，以更深入地了解是 SHYPO 导致睡眠障碍，还是睡眠障碍本身影响下丘脑-垂体-甲状腺轴的调节。
在 PubMed/MEDLINE、Embase、Web of Science 和 Scopus 数据库中搜索关于 SHYPO 患者睡眠质量和时长的原始研究。两名审查员独立筛选纳入文章、提取数据，并评估纳入研究的质量。
共检索到 8 项研究，包括 2916 例 SHYPO 患者和 18574 例健康对照者。观察到 7 项研究（共 8 项）总体上一致，即睡眠质量和/或时长下降与 SHYPO 之间存在正相关关系。5 项研究通过自我报告调查评估睡眠质量；只有 2 项研究使用活动记录仪（n=1）或多导睡眠图（n=1）同时评估主观和客观的睡眠质量；最后，1 项研究通过询问睡眠时间这一个问题评估睡眠质量的主观评估。由于人群来源、睡眠测量评估和 SHYPO 诊断标准的差异，研究之间存在高度异质性。
总体而言，现有文献数据表明 SHYPO 与睡眠障碍之间存在关联，但需要在具有同质研究设计和结局的更大患者人群中开展进一步研究。
