Razan Masarwy1,2,3,4, Liyona Kampel1,2,3, Omer J Ungar2,3, Anton Warshavsky2,3, Gilad Horowitz2,3, Eyal Rosenzweig2,3, Riva Tauman3,5, Nidal Muhanna6,7,8,9. 1. The Head and Neck Cancer Research Center, Tel Aviv University, Tel Aviv, Israel. 2. The Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel. 3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Head and Neck and Maxillofacial Surgery Department, Tel-Aviv Medical Center, 6 Weizmann St., 6423906, Tel-Aviv, Israel. 5. The Sagol-Sieratzki Center for Sleep Medicine, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel. 6. The Head and Neck Cancer Research Center, Tel Aviv University, Tel Aviv, Israel. nidalm@tlvmc.gov.il. 7. The Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel. nidalm@tlvmc.gov.il. 8. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. nidalm@tlvmc.gov.il. 9. Head and Neck and Maxillofacial Surgery Department, Tel-Aviv Medical Center, 6 Weizmann St., 6423906, Tel-Aviv, Israel. nidalm@tlvmc.gov.il.
Abstract
PURPOSE: Various thyroid pathologies are speculated to contribute to obstructive sleep apnea (OSA). The underlying mechanisms of the intricate relationship between OSA and thyroid structure and function, and whether thyroidectomy can alleviate OSA symptoms remain unclear. An assessment of the impact of thyroidectomy on OSA is warranted. METHODS: A systematic review of four electronic databases (PubMed (Medline), Embase, the Cochrane library, and ClinicalTrials.gov) was performed up to February 2022. The primary outcomes were preoperative and postoperative Apnea/Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Berlin questionnaire scores, and continuous positive airway pressure (CPAP) use. A meta-analysis of continuous measures and odd ratios was conducted. Small-scale studies underwent a qualitative meta-analysis. RESULTS: Six cohort studies on 221 OSA patients who underwent thyroidectomies were included. The results showed that thyroidectomy was associated with significant reduction in postoperative AHI (Mean difference [MD], -6.39, 95% CI, -12.46 to -0.32), however, no significant association was found with CPAP withdrawal (Odd ratio [OR], 0.38, 95% CI, 0.12-1.18). Neither the Berlin questionnaire score (OR, 0.19, 95% CI, 0.03-1.17) nor the ESS improved postoperatively (MD, -1.04, 95% CI, -6.37 to 4.29). CONCLUSION: This meta-analysis provides a quantitative estimate for the effect of the thyroidectomy on OSA and suggests that thyroidectomy is associated with limited clinical improvement of polysomnographic measures. Future large-scale, well-designed prospective studies are necessary to validate these findings and to refine accordingly the preoperative assessment of both medical conditions individually and in combination.
PURPOSE: Various thyroid pathologies are speculated to contribute to obstructive sleep apnea (OSA). The underlying mechanisms of the intricate relationship between OSA and thyroid structure and function, and whether thyroidectomy can alleviate OSA symptoms remain unclear. An assessment of the impact of thyroidectomy on OSA is warranted. METHODS: A systematic review of four electronic databases (PubMed (Medline), Embase, the Cochrane library, and ClinicalTrials.gov) was performed up to February 2022. The primary outcomes were preoperative and postoperative Apnea/Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Berlin questionnaire scores, and continuous positive airway pressure (CPAP) use. A meta-analysis of continuous measures and odd ratios was conducted. Small-scale studies underwent a qualitative meta-analysis. RESULTS: Six cohort studies on 221 OSA patients who underwent thyroidectomies were included. The results showed that thyroidectomy was associated with significant reduction in postoperative AHI (Mean difference [MD], -6.39, 95% CI, -12.46 to -0.32), however, no significant association was found with CPAP withdrawal (Odd ratio [OR], 0.38, 95% CI, 0.12-1.18). Neither the Berlin questionnaire score (OR, 0.19, 95% CI, 0.03-1.17) nor the ESS improved postoperatively (MD, -1.04, 95% CI, -6.37 to 4.29). CONCLUSION: This meta-analysis provides a quantitative estimate for the effect of the thyroidectomy on OSA and suggests that thyroidectomy is associated with limited clinical improvement of polysomnographic measures. Future large-scale, well-designed prospective studies are necessary to validate these findings and to refine accordingly the preoperative assessment of both medical conditions individually and in combination.
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Authors: Naresh M Punjabi; Brian S Caffo; James L Goodwin; Daniel J Gottlieb; Anne B Newman; George T O'Connor; David M Rapoport; Susan Redline; Helaine E Resnick; John A Robbins; Eyal Shahar; Mark L Unruh; Jonathan M Samet Journal: PLoS Med Date: 2009-08-18 Impact factor: 11.069