Skip to main content
SpringerLink
Log in

Clinical and polysomnographic findings of patients with large goiters

Polysomnographic findings of large goiters

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Introduction

Goiters cause a series of compressive symptoms, including dyspnea and dysphagia. There have been reports of the coexistence of this syndrome with obstructive sleep apnea (OSA). The objective of this study was to evaluate the prevalence of OSA in a group of patients with goiters.

Methods

Twenty-four patients with a mean age of 52.7 ± 12.7 years, including five males (20.8 %) and 19 (79.2 %) females, who were diagnosed with euthyroid goiters with volumes exceeding 100 ml were consecutively selected. The protocol consisted of sleep questionnaires, physical examinations, and baseline polysomnography measurements. Patients were divided into two groups, OSA and NOSA (no OSA), and all findings were compared between the two groups.

Results

Of the studied patients, 70.8 % had OSA (p = 0.004). Regarding clinical parameters, age (p = 0.001), Epworth Sleepiness Scale scores (p = 0.039) and complaints of habitual snoring (p < 0.001) had higher values in the OSA group. Regarding physical examination parameters, body mass index (p = 0.012), neck circumference (p = 0.009) and the presence of tracheal compression (p = 0.021) had higher values in the OSA group. The polysomnographic parameters that were significantly different between the two groups were the greater apnea and hypopnea index per hour of sleep (p < 0.001) and the lower minimum oxyhemoglobin saturation in the OSA group (p = 0.011).

Conclusions

There is a high prevalence of OSA in patients with goiters. The main findings that were associated with the presence of OSA are known clinical predictors of OSA and the presence of tracheal compression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Badr MS (1998) Pathophysiology of upper airway obstruction during sleep. Clin Chest Med 19:21–32

    Article  PubMed  CAS  Google Scholar 

  2. Kuna SRJ (2000) Anatomy and physiology of upper airway obstruction. In: Krieger MH, Roth T, Dement WC (eds) Principles and pratice of sleep medicine, 3rd edn. Saunders, Philadelphia, pp 840–858

    Google Scholar 

  3. Kapur VK, Koepsell TD, deMaine J, Hert R, Sandblom RE, Psaty BM (1998) Association of hypothyroidism and obstructive sleep apnea. Am J Respir Crit Care Med 158:1379–1383

    Article  PubMed  CAS  Google Scholar 

  4. Skjodt NM, Atkar R, Easton PA (1999) Screening for hypothyroidism in sleep apnea. Am J Respir Crit Care Med 160:732–735

    Article  PubMed  CAS  Google Scholar 

  5. Winkelman JW, Goldman H, Piscatelli N, Lukas SE, Dorsey CM, Cunningham S (1996) Are thyroid function tests necessary in patients with suspected sleep apnea? Sleep 19:790–793

    PubMed  CAS  Google Scholar 

  6. Stafford N, Youngs R, Waldron J, Baer S, Randall C (1986) Obstructive sleep apnoea in association with retrosternal goitre and acromegaly. J Laryngol Otol 100:861–863

    Article  PubMed  CAS  Google Scholar 

  7. Deegan PC, McNamara VM, Morgan WE (1997) Goitre: a cause of obstructive sleep apnoea in euthyroid patients. Eur Respir J 10:500–502

    Article  PubMed  CAS  Google Scholar 

  8. Eloy JA, Omerhodzic S, Som PM, Genden EM (2007) Goitrous Hashimoto's thyroiditis presenting as obstructive sleep apnea. Thyroid 17:691–692

    Article  PubMed  Google Scholar 

  9. Carvalho MB (2007) Diagnóstico e tratamento dos bócios subesternais. In: Junior CF (ed) Tratado de tireóide e paratireóide. Editora Rúbio, Rio de Janeiro

    Google Scholar 

  10. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the apnea syndrome. Ann Intern Med 131:485–491

    Article  PubMed  CAS  Google Scholar 

  11. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna Barreto SS, Johns MW (2009) Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol 35:877–883

    Article  PubMed  Google Scholar 

  12. Stradling JR, Crosby JH (1991) Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 46:85–90

    Article  PubMed  CAS  Google Scholar 

  13. Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC (1981) Volumetric analysis of thyroid lobes by real-time ultrasound. Dtsch Med Wochenschr 106:1338–1340

    Article  PubMed  CAS  Google Scholar 

  14. Nygaard B, Nygaard T, Court-Payen M, Jensen LI, Søe-Jensen P, Gerhard Nielsen K, Fugl M, Hegedüs L (2002) Thyroid volume measured by ultrasonography and CT. Acta Radiol 43:269–274

    Article  PubMed  CAS  Google Scholar 

  15. Cougard P, Matet P, Goudet P, Bambili R, Viard H, Vaillant G, Vergès B, Brun JM (1992) Substernal goiters. 218 operated cases. Ann Endocrinol 53:230–235

    CAS  Google Scholar 

  16. Rechtschtaffen A, Kales A (eds) (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. UCLA Brain Information Service/Brain Research Institute, Los Angeles

    Google Scholar 

  17. American Academy of Sleep Medicine (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. American Academy of sleep medicine task force. Sleep 22:667–689

    Google Scholar 

  18. American Sleep Disorders Association (ASDA) (1992) EEG arrousals: scoring rules and examples: a preliminary report from the sleep disorders Atlas Task Force. Sleep 2:173–184

    Google Scholar 

  19. American Academy of Sleep Medicine (2005) International classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  20. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR (2010) Obstructive sleep apnea syndrome in the Sao Paulo epidemiologic sleep study. Sleep Med 11:441–446

    Article  PubMed  Google Scholar 

  21. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  PubMed  Google Scholar 

  22. Tan GH, Gharib H (1999) Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 126:226–231

    Article  Google Scholar 

  23. Subramanian S, Jayaraman G, Majid H, Aguilar R, Surani S (2011) Influence of gender and anthropometric measures on severity of obstructive sleep apnea. Sleep Breath. doi:10.1007/s11325-011-0607-9

  24. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  PubMed  CAS  Google Scholar 

  25. Ahmadi N, Chung SA, Gibbs A, Shapiro CM (2008) The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance. Sleep Breath 12:39–45

    Article  PubMed  Google Scholar 

  26. Stang MT, Armstrong MJ, Ogilvie JB, Yip L, McCoy KL, Faber CN, Carty SE (2012) Positional dyspnea and tracheal compression as indications for goiter resection. Arch Surg. doi:10.1001/archsurg.2012.96

  27. Karabeyoglu M, Unal B, Dirican A, Kocer B, Gur AS, Bozkurt B, Cengiz O, Soran A (2009) The relation between preoperative ultrasonographic thyroid volume analysis and thyroidectomy complications. Endocr Regul 43:83–87

    PubMed  Google Scholar 

Download references

Acknowledgment

Publication is supported by AFIP, FAPESP/CEPID, and CNPq.

Conflict of interest

The authors report no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil

    Leonardo Haddad, Fernanda L. M. Haddad, Luis Carlos Gregório & Marcio Abrahão

  2. Sleep Medicine and Biology, Psychobiology Department, Federal University of São Paulo, São Paulo, Brazil

    Fernanda L. M. Haddad, Lia Bittencourt & Sergio Tufik

  3. Rua Napoleao de Barros, 925, Vila Clementino, São Paulo, São Paulo, Brazil, CEP: 04024-002

    Fernanda L. M. Haddad

Authors
  1. Leonardo Haddad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fernanda L. M. Haddad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lia Bittencourt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luis Carlos Gregório
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sergio Tufik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcio Abrahão
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernanda L. M. Haddad.

Additional information

This study was performed at the Federal University of São Paulo—UNIFESP—Brazil

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haddad, L., Haddad, F.L.M., Bittencourt, L. et al. Clinical and polysomnographic findings of patients with large goiters. Sleep Breath 17, 673–678 (2013). https://doi.org/10.1007/s11325-012-0741-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-012-0741-z

Keywords

Search

Navigation