Xie Yushan, Zhang Hongli, Cao Zine, Zhou Yanuo, Lu Chendi, Yin Libo, Zhu Simin, Su Yonglong, Niu Xiaoxin, Ma Lina, Yuan Yuqi, Zhang Yitong, Wang Zitong, Liu Haiqin, Ren Xiaoyong, Shi Yewen
Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.
Shaanxi Provincial Key Laboratory for Precision Diagnosis and Treatment of Otorhinolaryngology, Xi'an, People's Republic of China.
Nat Sci Sleep. 2025 Jul 29;17:1727-1741. doi: 10.2147/NSS.S507318. eCollection 2025.
This study unveils the complex interplay among obstructive sleep apnea (OSA), thyroid function, and morphological changes.
Data from 1,102 patients were collected retrospectively from the Department of Otorhinolaryngology-Head and Neck Surgery of the Second Affiliated Hospital of Xi'an Jiaotong University from 2012 to 2023. The patients were divided into severe and non-severe OSA groups according to their polysomnography results. The data were analyzed by sex and age stratification.
Serum free triiodothyronine (FT3), total triiodothyronine (TT3), and reverse triiodothyronine (RT3) were higher in severe OSA group in the total population ( < 0.05). Similar trends were observed in male but not in female. FT3 and TT3 are higher in the severe group in the nonelderly population (age < 60) ( < 0.05), and RT3 is higher in the severe group in the elderly population (age ≥ 60) ( < 0.05). In addition, we first reveal that RT3 is associated with the diameter of the left inferior thyroid artery (L-ITA) (r=0.394, < 0.05) and lowest transcutaneous oxygen saturation at night (lowest SpO) (r=-0.269, < 0.05). The severe OSA group showed larger thyroid volume and isthmus length, as well as the thicker ITA diameter and lower left thyroid lobe resistance index (RI) (all < 0.05).
Our study demonstrates a significant association between thyroid function/morphology and OSA, with distinct sex- and age-related differences. Reduced RI in severe OSA suggests its clinical utility in assessing vascular health. Increased thyroid volume and isthmus length in severe OSA may reflect ITA-related changes. These findings support our prior observations of rising thyroid hormone levels with OSA progression and highlight the need for sex- and age-stratified analyses. Integrated evaluation of thyroid function and morphology is essential for understanding OSA-thyroid pathophysiology.
本研究揭示阻塞性睡眠呼吸暂停（OSA）、甲状腺功能和形态学变化之间的复杂相互作用。
回顾性收集2012年至2023年西安交通大学第二附属医院耳鼻咽喉头颈外科1102例患者的数据。根据多导睡眠图结果将患者分为重度和非重度OSA组。数据按性别和年龄分层进行分析。
总体人群中，重度OSA组血清游离三碘甲状腺原氨酸（FT3）、总三碘甲状腺原氨酸（TT3）和反三碘甲状腺原氨酸（RT3）较高（<0.05）。男性中观察到类似趋势，女性则未观察到。非老年人群（年龄<60岁）中重度组FT3和TT3较高（<0.05），老年人群（年龄≥60岁）中重度组RT3较高（<0.05）。此外，我们首次发现RT3与左甲状腺下动脉（L-ITA）直径相关（r = 0.394，<0.05），与夜间最低经皮血氧饱和度（最低SpO）相关（r = -0.269，<0.05）。重度OSA组甲状腺体积和峡部长度较大，ITA直径较厚，左甲状腺叶阻力指数（RI）较低（均<0.05）。
我们的研究表明甲状腺功能/形态与OSA之间存在显著关联，且存在明显的性别和年龄差异。重度OSA中RI降低表明其在评估血管健康方面的临床应用价值。重度OSA中甲状腺体积和峡部长度增加可能反映了与ITA相关的变化。这些发现支持了我们之前关于随着OSA进展甲状腺激素水平升高的观察结果，并强调了进行性别和年龄分层分析的必要性。对甲状腺功能和形态进行综合评估对于理解OSA-甲状腺病理生理学至关重要。
