Hypothyroidism and its Association with Sleep Apnea Among Adults in The United States: NHANES 2007-2008.

The association between hypothyroidism and sleep apnea (SA) has been previously studied, but results are discrepant and mostly based on small population studies.To determine whether there is a positive association between hypothyroidism and SA in the U.S. population.Cross-sectional study.U.S. National Health and Nutrition Examination Survey (NHANES), 2007-2008.We included all subjects above the age of 18 years who met inclusion criteria. Participants not on antithyroid medication with a thyroid stimulating hormone (TSH) >5.6 mIU/L and those on thyroid hormone replacement regardless of TSH were categorized as hypothyroid. Participants not on thyroid hormone replacement with a TSH<0.34 mIU/L and those on antithyroid medications regardless of TSH were categorized as hyperthyroid. Participants not on thyroid hormone replacement or antithyroid medication who had a TSH?0.34 and ?5.6 mIU/L were categorized as euthyroid. The diagnosis of SA was based on participants' response when asked if they had been diagnosed with SA by their doctors.None.Multivariate logistic regression analyses were performed to determine the association between hypothyroidism and SA.5,515 adults were included for data analysis. The prevalence of hypothyroidism and hyperthyroidism were calculated at 9.47% and 1.19%, respectively. Multivariate logistic regression analysis adjusted for demographics, health care access, body mass index, socioeconomic factor, alcohol use, smoking, and other comorbidities demonstrated a significant association between hypothyroidism and SA (OR=1.88, 95% CI: 1.24-2.84, P<0.01).Hypothyroidism is associated with SA after adjustment for potential confounding variables.

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Upper Airway Stimulation versus Positive Airway Pressure Impact on Blood Pressure and Sleepiness Symptoms in Obstructive Sleep Apnea.

Positive airway pressure (PAP) and upper airway stimulation (UAS) are approved obstructive sleep apnea (OSA) treatment options.. Although the effect of PAP on improvement in blood pressure (BP) and daytime sleepiness (defined by Epworth Sleepiness Scale, ESS) has been established, the impact of UAS on BP remains unclear. We hypothesize that PAP and UAS will confer improvements in BP and daytime sleepiness.Clinic-based BP and ESS were compared between 517 OSA (apnea hypopnea index (AHI), 15-65) patients with body mass index <35 kg/m2 initiating PAP therapy (2010-2014) at Cleveland Clinic and 320 patients with UAS implantation (2015-2017) via an international registry with 2-6 month follow-up. Mixed-effect models were used to compare outcomes in 201 patients in each arm after propensity matching.PAP showed greater improvement in diastolic BP (mean difference of change between groups 3.7 mmHg, p <0.001) and mean arterial pressure (mean difference of change between groups 2.8 mmHg, p=0.008) compared to UAS.UAS showed greater improvement in ESS versus PAP (mean difference of change between PAP and UAS groups -0.8, p=0.046). UAS therapy usage was 6.2 hours/week greater than PAP patients (95% CI = 3.3 to 9.0). Results were consistent after adjusting for therapy adherence.PAP showed greater improvement in BP, potentially reflecting enhanced ability of PAP to exert beneficial mechanical intrathoracic cardiac and vascular influences. BP measurement error in the UAS group may also have accounted for findings. Greater improvement in sleepiness symptoms were noted in UAS compared to PAP.

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