Prospective Correlation of Risk of Obstructive Sleep Apnea With Severe Clinical Features of Thyroid Eye Disease

Abstract

Purpose: To evaluate the association between risk of obstructive sleep apnea (OSA) and severity of thyroid eye disease (TED) using a validated OSA screening tool. Methods: A prospective, observational cohort study was performed. New adult TED patients were offered OSA screening with the Snoring Tired Observed Pressure (STOP)-Bang survey during their initial evaluation. Clinical examination and treatment for TED were standard of care and utilized the International Thyroid Eye Disease Society Vision Inflammation Strabismus Appearance system. At the conclusion of the study period, analysis was performed correlating maximum severity of TED signs and symptoms between high- and low-risk OSA groups. Multivariate logistic and linear regression analyses were also performed to analyze the association between the numerical STOP-Bang score and maximum severity of the potentially actionable clinical features of TED (compressive optic neuropathy, vertical prism deviation, horizontal prism deviation, exophthalmos, vertical fissure height). Results: Eighty-five patients met inclusion criteria. Twenty-eight percent were at high risk of OSA (STOP-Bang score of 3 or higher). When comparing the low- and high-risk cohorts, increased risk of OSA was significantly associated with the development of TED compressive optic neuropathy (p = 0.014), conjunctival injection (p = 0.027), chemosis (p = 0.013), upper eyelid edema (p = 0.024), lower eyelid edema (p = 0.003), eyelid erythema (p = 0.037), and vertical strabismus (p = 0.047). In the multivariate regression analyses, higher STOP-Bang scores correlated with increased risk of TED compressive optic neuropathy (p = 0.006), vertical strabismus (p = 0.019), and higher subjective diplopia scores (p = 0.045). Conclusions: Increased risk of OSA, as determined by the STOP-Bang survey, is associated with increased severity of multiple clinical features of TED, including TED compressive optic neuropathy and strabismus.

Assessment of risk of obstructive sleep apnea with thyroid eye disease and its activity

“…[ 8 ] In further expansion of this study, Godfrey et al . [ 9 ] reported that the elevated risk of OSA (as determined by the STOP-Bang survey) is associated with the development and/or increased maximum severity of a number of clinical features of TED, including TED-CON (47.8% vs. 18.3%, P = 0.014), chemosis ( P = 0.013), conjunctival injection (63.6% vs. 27.1%, P = 0.027), upper eyelid edema ( P = 0.024), lower eyelid edema ( P = 0.003), eyelid erythema (33.3% vs. 10.3%, P = 0.037), and vertical strabismus (31.8% vs. 10.3%, P = 0.047). In our study, we did not find any association between OSA and these clinical features or the severity of the disease.…”

“…Habib et al .,[ 8 ] in their retrospective observational study, have shown the association of risk of OSA and TED-compressive optic neuropathy (TED-CON). Recently, Godfrey et al .,[ 9 ] in a prospective cohort study of 85 patients, have shown an association of high risk of OSA with the severity of TED using the Snoring Tired Observed Pressure (STOP)-Bang survey. Since the clinical signs of activity in TED involve the role of inflammatory mediators and OSA is associated with systemic activation of inflammatory pathways, there is likely to be a role of OSA in mediating the clinical activity in TED.…”

Update on thyroid eye disease: Regional variations in prevalence, diagnosis, and management

“…Several observational studies have reported a correlation between OSA and the severity of TED presentations, including DON. [ 77 78 ] No studies to date have examined the effect of sleep apnea treatment on TED outcomes.…”

Ocular Complications of Obstructive Sleep Apnea

“…A retrospective study of 109 individuals demonstrated that the prevalence of higher-risk OSA in patients with compressive optic neuropathy from TED was significantly higher than in those without TED-related compressive optic neuropathy [ 78 ]. Another prospective observational cohort study observing 85 patients also revealed that the risk of compressive optic neuropathy and vertical strabismus from TED was significantly higher in patients with a higher risk of OSA [ 79 ]. In terms of the effects from CPAP, one report demonstrated normalization of fT3 after CPAP treatment in OSA patients with euthyroid sick syndrome [ 80 ].…”

“… Habib, 2019 [ 78 ] USA 109 The prevalence of higher-risk OSA in patients with compressive optic neuropathy from TED was significantly higher than those without TED-related compressive optic neuropathy (59.2% vs. 32.8%, p = 0.006). Godfrey, 2020 [ 79 ] USA 85 A prospective observational cohort study revealed that the risk of compressive optic neuropathy ( p = 0.014) and vertical strabismus ( p = 0.047) from TED was significantly higher in patients with a higher risk of OSA. Petrone, 2016 [ 80 ] Italy 185 Normalization of fT3 was noted after CPAP treatment in OSA patients with euthyroid sick syndrome.…”