TY - JOUR
T1 - The impact of thyroidectomy on obstructive sleep apnea
T2 - a systematic review and meta-analysis
AU - Masarwy, Razan
AU - Kampel, Liyona
AU - Ungar, Omer J.
AU - Warshavsky, Anton
AU - Horowitz, Gilad
AU - Rosenzweig, Eyal
AU - Tauman, Riva
AU - Muhanna, Nidal
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - Goiter
KW - Obstructive sleep apnea
KW - Polysomnography
KW - Sleep-disordered breathing
KW - Thyroidectomy
UR - http://www.scopus.com/inward/record.url?scp=85132156425&partnerID=8YFLogxK
U2 - 10.1007/s00405-022-07461-0
DO - 10.1007/s00405-022-07461-0
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C2 - 35723730
AN - SCOPUS:85132156425
SN - 0937-4477
VL - 279
SP - 5801
EP - 5811
JO - European Archives of Oto-Rhino-Laryngology
JF - European Archives of Oto-Rhino-Laryngology
IS - 12
ER -