Thyroid surgery relieved sleep apnea symptoms

Annual Meeting of the ATA

INDIAN WELLS, Calif. — After undergoing thyroidectomy, patients struggling with snoring and other aspects of obstructive sleep apnea noted significant improvement in their symptoms.

Approximately 20% of the population has obstructive sleep apnea, Alexandra Reiher, MD, clinical endocrinologist at NorthShore University HealthSystem, and colleagues said, and when untreated, the disease can elevate one's risk for mortality. They pointed out that patients with goiters often report experiencing compressive symptoms, but research has yet to pin down an association between an enlarged thyroid gland and these issues.

"We know from more generalized surveys from before and after thyroidectomy that some patients report symptoms of snoring improving, but it hasn't been evaluated with a validated questionnaire and hasn't been looked at with particular symptoms to see what exactly is improving. Is it how often they snore? Is it how often they fall asleep during the day? We wanted to find out if symptoms do improve with a validated questionnaire and, if so, which ones were improving," Reiher told Endocrine Today.

Reiher and colleagues therefore administered the Berlin questionnaire, a sleep apnea assessment tool, to patients who reported symptoms of snoring before and 8 weeks after thyroidectomy to evaluate for any improvement in symptoms. Of 45 patients who completed pre- and post-operative evaluations, 71% scored positive in at least two symptom categories on the questionnaire, meaning that they were at high risk for sleep apnea. After surgery, however, this number decreased to 51% (P=.002).

Results also indicated considerable improvement in overall scores after surgery (mean 2 vs. 1.6; P<.0001), especially notable decreases in snoring frequency (P=.002) and whether patients' snoring bothered other people (P=.004). Additionally, the researchers observed a drop in how often patients nodded off during the day (P=.02).

"Obstructive sleep apnea is obviously a complex problem with numerous causes, but we find it encouraging that thyroidectomy alone can provide significant improvements in nearly a third of patients, regardless of gland size," study researcher Rebecca Sippel, MD, assistant professor in the division of surgery and chief of the section of endocrine surgery at the University of Wisconsin School of Medicine and Public Health, said in a press release.

In light of their findings, the researchers urged evaluation for goiter in those with obstructive sleep apnea, noting that surgery may mitigate symptoms in these patients. Reiher also suggested a follow-up study, as well as other areas for research.

"A good follow-up study to this would be to actually perform overnight sleep studies before and after surgery and see if patients' apneic scores improve," she said. "That would be a more direct way of measuring improvement."

For more information:

Reiher AE. Poster 171. Presented at: the 81st Annual Meeting of the American Thyroid Association; Oct. 26-30, 2011; Indian Wells, Calif.

Disclosure: Dr. Reiher reports no relevant financial disclosures.

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