What is Endocrinology -How does sleep apnea caused by GH overproduction vary from sleep apnea caused by thyroid hormone deficiency?
A large percentage of central sleep apnea is linked to GH excess, whereas hypothyroidism is virtually always linked to OSA. PSG tests finally reveal sleep apnea in up to 60% of acromegaly patients. More than 30% of people in one series had central sleep apnea. The lack of occlusive posterior tongue movement during sleep, as demonstrated by endoscopy, rules out macroglossia. This claim is further corroborated by the finding that, when compared to individuals with OSA, these patients exhibit higher ventilatory responsiveness and lower arterial carbon dioxide levels while awake. It is unclear what causes the central sleep apnea in these people.
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What is Endocrinology - What endocrine conditions are linked to obstructive sleep apnea (OSA)?9/22/2022 What is Endocrinology - What endocrine conditions are linked to obstructive sleep apnea (OSA)?
The most prevalent conditions are polycystic ovarian syndrome, acromegaly, and hypothyroidism (PCOS). Although it was formerly believed that all OSA patients had subclinical hypothyroidism, this has since been disproven. According to the available data, roughly 30% of hypothyroid patients also have OSA. In most of these people, OSA is curable with the right thyroid hormone replacement therapy. 30% of nonobese, middle-aged men and women with newly diagnosed symptomatic hypothyroidism had OSA by PSG at study start, according to one prospective investigation. In 84% of these cases, the OSA was reversed as soon as the TSH level returned to normal. Finally, there is a significant correlation between the likelihood and severity of OSA in PCOS and insulin levels and markers of glucose tolerance. Additionally, insulin levels are considerably greater in PCOS-positive women with normal glucose tolerance who are at high versus low OSA risk, regardless of BMI. It makes sense to evaluate restorative sleep measurements, sleep patterns, and sleep behaviours in all PCOS patients. What is Endocrinology - Does the comorbidity of obstructive sleep apnea (OSA) affect the evaluation of metanephrines and catecholamines while screening for pheochromocytoma in light of the elevated SNS tone in OSA?
Yes. Similar to how acute catecholamine elevations are linked to myocardial infarctions, cerebral vascular accidents, and acute heart failure, OSA causes an appropriate release of catecholamines in response to physiologic stress or disease. In the case of undiagnosed or undertreated OSA, a 24-hour urine collection would probably reveal higher levels of catecholamines and metanephrine. This could incorrectly point to a pheochromocytoma diagnosis. What is Endocrinology - What distinguishes sleep apnea from sleep deprivation?
When one is sleep deprived, they do not sleep yet nevertheless breathe regularly. When someone has OSA, they sleep yet have breathing problems. As long as it is linked to daytime sleepiness, the AASM recognises volitional sleep deprivation as behaviorally produced insufficient sleep syndrome. A standardised instrument like the Epworth Sleepiness Scale can be used to objectively assess excessive daytime sleepiness (EDS) (ESS). In the ESS, the interviewer presents the patient with eight different life scenarios and asks them to rate their own perceived level of sleep pressure in each scenario using a four-point scale (0–3). A score of 0 indicates that the patient feels no sleep pressure in the scenario, while a score of 3 indicates that the patient perceives significant sleep pressure in the scenario. The patient must respond to all eight questions in order for the total score from all 8 life circumstances to be valid for use in clinical practise. A higher than 9 ESS score is consistent with EDS. Patients with acute or chronic sleep shortness fight falling asleep despite having normal gas exchange. In OSA, despite prolonged thoracic and abdominal breathing effort, the upper airway repeatedly collapses, causing apneic and hypopneic episodes. As a result, the diaphragm, chest wall, and upper airway are mechanically loaded. Hypoxia, hypercarbia, and a significant rise in adrenergic tone ensue. Endocrine reactivity and the typical sleep-wake cycle are frequently affected by OSA. Both can be responsible for exhaustion and drowsiness during the day. The patient's sleep continuity is normal if EDS is a result of sleep deprivation, and it is frequently accompanied by a rise in SWS. Remember that daytime recovery sleep has an inhibitory effect on TSH; if nocturnal sleep deprivation is followed by daytime recovery sleep, the inhibitory effect of sleep will lower TSH. What is Endocrinology - Explain what sleep deprivation is. How frequent is it?
Lack of sleep can be sudden or ongoing. Acute sleep loss is defined as not getting any sleep for 24 hours, but chronic sleep deprivation is defined as sleeping less than 6 hours every night for six nights or longer. People in developed countries are sleeping fewer hours. For instance, in the United States, more than 30% of adults under the age of 64 report sleeping fewer than 6 hours each night, a statistic that makes it clear that many patients are developing chronic sleep deprivation. What is Endocrinology - How common is obstructive sleep apnea (OSA) today?
The prevalence varies depending on how OSA is defined. Early epidemiologic studies, mostly on white men, reported that up to 4% of patients had OSA and between 60% and 90% were obese. For individuals aged 30 to 60, the typical prevalence of OSA is 24% for males and 9% for women. Genetic craniofacial traits like retrognathia are linked to OSA in persons who are not fat. The prevalence may become specific to communities or ethnicities as OSA data mature. Body mass index (BMI) and age were positively connected in Asian nonobese male office employees, but weight was less so than in white, non-Asian subjects. In Chinese populations, it is believed that risk factors for OSA other than obesity, such as pharyngeal narrowing, retrognathia or micrognathia, and pharyngeal collapsibility, take higher clinical relevance. What is Endocrinology - What are respiratory events, exactly?
Apneas, hypopneas, and respiratory effort-related arousals are examples of respiratory events (RERAs). An apneic episode is defined as a minimum 90% reduction in airflow from baseline that lasts for at least 10 seconds (try holding your own breath for 10 seconds). According to pulse oximetry, hypopnea is characterised by a 10 second period of at least a 30% drop in airflow that causes a desaturation of at least 4%. In contrast, if an observed event does not satisfy hypopnea or apnea criteria, RERA criteria should be sought. RERA is described as a series of breaths lasting more than 10 seconds, which are linked to increased respiratory effort and awaken the sleeper. Apneas, hypopneas, and RERAs are to be scored in the standard PSG interpretation, according to the AASM, if they are present. The apnea-hypopnea index measures the average number of apneas and hypopneas in a single hour (AHI). The average number of apneas, hypopneas, and RERAs should be determined if RERAs are present, though. The respiratory disturbance index is used to describe this (RDI). Even though the terms are occasionally used interchangeably, the AHI and RDI are not equal—this could lead to mistake. What is Endocrinology - How does obstructive sleep apnea (OSA) differ from sleep disordered breathing (SDB) and what does it mean?
The interchangeable use of the words sleep-related breathing disorders (SRBD), SDB, and OSA in the literature and in sleep laboratory results causes confusion. Similar to how chronic obstructive pulmonary disease (COPD) serves as a generic heading for various distinct disease entities, SRBD and SDB are diseases under which other disorders are grouped. SRBD includes OSA syndromes as well as adult and paediatric central apnea syndromes. In contrast, polysomnography is used to diagnose OSA, a specific condition (PSG). On the basis of complaints made by the patient or their bed mate, OSA may be suspected. Unintentional sleep episodes when awake, daytime tiredness, unrefreshing sleep, exhaustion or sleeplessness, waking from sleep with gasping or choking, loud snoring, and breathing disturbances are a few examples of these problems. If there are complaints from the patient or bed partner, the PSG requirements are less strict. The PSG must have five or more respiratory episodes per hour of sleep associated with increased respiratory effort in addition to complaints. The PSG must instead contain 15 or more of these respiratory episodes in the absence of a history of complaints. In either situation, a diagnosis of OSA must rule out any underlying medical, neurological, and/or substance addiction conditions. The risk of OSA can also be raised by several prescription drugs. What is Endocrinology - How does hormone release change as we age?
Hormonal alterations are hypothesised to be the result of changes in sleep architecture with ageing. Loss of SWS and REM sleep, as well as increased sleep fragmentation, are both symptoms of normal ageing. TSH, cortisol, and testosterone increase predominantly on the basis of the circadian cycle, whereas GH and PRL rise primarily in connection to the SWS of NREM sleep. SWS and GH secretion have a dosage response association in younger males. For instance, SWS accounts for approximately 20% of the sleep time in males and boys aged 16 to 25 and declines to 5% to 10% after age 40. This is linked to a 350 mg GH release during sleep in people between the ages of 16 and 25, but not more than 100 mg in people over the age of 35. Regardless of gender, the majority of the PRL released throughout a 24-hour period occurs when you're asleep. With age, nocturnal PRL release declines by over 50%. With age, the magnitude of the circadian fluctuations in cortisol and TSH is less pronounced. Age also dampens day-night TSH oscillations. What is Endocrinology -How do circadian rhythms and sleep-wake cycles affect insulin and glucose levels?
Both Process-C and SWH have an impact on insulin and glucose levels. Studies on healthy persons showed that during nocturnal sleep, glucose levels rose by 30% and insulin levels by 60%. A finding that suggests circadian modulation is that during sleep deprivation, glucose and insulin secretion rates rise at habitual sleep time, but to a much smaller extent. However, secretion rates of both insulin and glucose significantly rise during recovery sleep, indicating that sleep itself may be modulating these processes. |
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