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BMC Pulmonary Medicine
Published in: BMC Pulmonary Medicine 1/2024

Open Access 01-12-2024 | Hypothyroidism | Research

The association of lymphocyte with hypothyroidism in obstructive sleep apnea

Authors: Xiaoyan Fang, Le Wang, Chong Xu, Tuai Xue, Mingchu Zhang, Lingling Liu, Jie Cao, Jing Zhang

Published in: BMC Pulmonary Medicine | Issue 1/2024

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Abstract

Purpose

Obstructive sleep apnea (OSA) is a common sleep-breathing disorder. Numerous investigations have found a strong inherent relationship between OSA and hypothyroidism. Studies suggest that lymphocytes may be involved in the development of hypothyroidism in patients with OSA. This study aimed to assess the association between lymphocytes and hypothyroidism in OSA patients.

Patients and methods

This study involved 920 patients with OSA who underwent nocturnal sleep monitoring, thyroid function testing, and routine blood tests. In patients with OSA, logistic regression analysis indicated independent predictors of hypothyroidism. The cutoff level of lymphocyte count was determined using a receiver operating characteristic (ROC) analysis to predict the occurrence of hypothyroidism in individuals with OSA.

Results

This study comprised 920 OSA patients (617 males and 303 women), 879 with normal thyroid function, and 41 with hypothyroidism, with a hypothyroidism incidence of 4.46%. In the entire OSA population and male OSA patients, the number of lymphocytes was significantly higher in the hypothyroid group than in the control group (p = 0.002 and 0.020, respectively). In addition, among the OSA population younger than 60 years old and patients with mild to moderate OSA, lymphocytes were found to be considerably more in the hypothyroid group than in the euthyroid group. Lymphocyte count, ESS, and sex were all independent predictors of hypothyroidism development in OSA patients. According to ROC curve analysis, the risk of hypothyroidism increases with increasing lymphocyte count in the total patient population, with an optimal diagnostic cutoff point of 2.5 (× 10*9/L).

Conclusions

The prevalence of hypothyroidism in patients with OSA increases as the number of lymphocytes increases. Lymphocyte count can be used as an independent predictor of the occurrence of hypothyroidism, and it has a diagnostic value for OSA combined with hypothyroidism.
Literature
1.
Qureshi A, Ballard RD. Obstructive sleep apnea. J Allergy Clin Immunol. 2003;112(4):643–51 quiz 652.CrossRefPubMed
2.
Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;34:70–81.CrossRefPubMed
3.
Tondo P, Fanfulla F, Sabato R, Scioscia G, Foschino Barbaro MP, Lacedonia D. Obstructive sleep apnoea-hypopnoea syndrome: state of the art. Minerva Med. 2023;114(1):74–89.CrossRefPubMed
4.
Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071–8.PubMedPubMedCentral
5.
Tondo P, Fanfulla F, Scioscia G, Sabato R, Salvemini M, De Pace CC, Foschino Barbaro MP, Lacedonia D. The Burden of Respiratory Alterations during Sleep on Comorbidities in Obstructive Sleep Apnoea (OSA). Brain Sci. 2022;12(10):1359.
6.
Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus JH, Dayan CM, Okosieme OE. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018;14(5):301–16.CrossRefPubMed
7.
Biondi B. Natural history, diagnosis and management of subclinical thyroid dysfunction. Best Pract Res Clin Endocrinol Metab. 2012;26(4):431–46.CrossRefPubMed
8.
Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev. 2008;29(1):76–131.CrossRefPubMed
9.
Ralli M, Angeletti D, Fiore M, D’Aguanno V, Lambiase A, Artico M, de Vincentiis M, Greco A. Hashimoto’s thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. Autoimmun Rev. 2020;19(10): 102649.CrossRefPubMed
10.
Ganesh BB, Bhattacharya P, Gopisetty A, Prabhakar BS. Role of cytokines in the pathogenesis and suppression of thyroid autoimmunity. Journal of interferon & cytokine research : the official journal of the International Society for Interferon and Cytokine Research. 2011;31(10):721–31.CrossRef
11.
Ragusa F, Fallahi P, Elia G, Gonnella D, Paparo SR, Giusti C, Churilov LP, Ferrari SM, Antonelli A. Hashimotos’ thyroiditis: Epidemiology, pathogenesis, clinic and therapy. Best Pract Res Clin Endocrinol Metab. 2019;33(6): 101367.CrossRefPubMed
12.
Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387–94.CrossRefPubMed
13.
Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, Franklyn JA, Hershman JM, Burman KD, Denke MA, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291(2):228–38.CrossRefPubMed
14.
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.CrossRefPubMed
15.
Pancholi C, Chaudhary SC, Gupta KK, Sawlani KK, Verma SK, Singh A, Verma AK, Usman K, Atam V. Obstructive sleep apnea in hypothyroidism. Ann Afr Med. 2022;21(4):403–9.CrossRefPubMedPubMedCentral
16.
Jha A, Sharma SK, Tandon N, Lakshmy R, Kadhiravan T, Handa KK, Gupta R, Pandey RM, Chaturvedi PK. Thyroxine replacement therapy reverses sleep-disordered breathing in patients with primary hypothyroidism. Sleep Med. 2006;7(1):55–61.CrossRefPubMed
17.
Sorensen JR, Winther KH, Bonnema SJ, Godballe C, Hegedüs L. Respiratory Manifestations of Hypothyroidism: A Systematic Review. Thyroid. 2016;26(11):1519–27.CrossRefPubMed
18.
Zhang M, Zhang W, Tan J, Zhao M, Zhang Q, Lei P. Role of hypothyroidism in obstructive sleep apnea: a meta-analysis. Curr Med Res Opin. 2016;32(6):1059–64.CrossRefPubMed
19.
Devdhar M, Ousman YH, Burman KD. Hypothyroidism. Endocrinol Metab Clin North Am. 2007;36(3):595–615 , v.CrossRefPubMed
20.
Siafakas NM, Salesiotou V, Filaditaki V, Tzanakis N, Thalassinos N, Bouros D. Respiratory muscle strength in hypothyroidism. Chest. 1992;102(1):189–94.CrossRefPubMed
21.
Martinez FJ, Bermudez-Gomez M, Celli BR. Hypothyroidism. A reversible cause of diaphragmatic dysfunction. Chest. 1989;96(5):1059–63.CrossRefPubMed
22.
Attal P, Chanson P. Endocrine aspects of obstructive sleep apnea. J Clin Endocrinol Metab. 2010;95(2):483–95.CrossRefPubMed
23.
Alberti A, Sarchielli P, Gallinella E, Floridi A, Floridi A, Mazzotta G, Gallai V. Plasma cytokine levels in patients with obstructive sleep apnea syndrome: a preliminary study. J Sleep Res. 2003;12(4):305–11.CrossRefPubMed
24.
Drugarin D, Negru S, Koreck A, Zosin I, Cristea C. The pattern of a T(H)1 cytokine in autoimmune thyroiditis. Immunol Lett. 2000;71(2):73–7.CrossRefPubMed
25.
Nanba T, Watanabe M, Inoue N, Iwatani Y. Increases of the Th1/Th2 cell ratio in severe Hashimoto’s disease and in the proportion of Th17 cells in intractable Graves’ disease. Thyroid. 2009;19(5):495–501.CrossRefPubMed
26.
Crane IJ, Forrester JV. Th1 and Th2 lymphocytes in autoimmune disease. Crit Rev Immunol. 2005;25(2):75–102.CrossRefPubMed
27.
Zhang N, Li Y, Li B, Xu W. Correlation between peripheral blood Th17 cells and carotid intima-media thickness in OSA patients. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020;34(8):747–51.
28.
Ye J, Liu H, Zhang G, Li P, Wang Z, Huang S, Yang Q, Li Y. The treg/th17 imbalance in patients with obstructive sleep apnoea syndrome. Mediators Inflamm. 2012;2012: 815308.CrossRefPubMedPubMedCentral
29.
Ying L, Li H, Pan Z, Ma S, Zhang P, Wang Q, Lu G, Zhou J. Relationship of redundant Th17 cells and IL-17A, but not IL-17 F, with the severity of obstructive sleep apnoea/hypopnoea syndrome (OSAHS). BMC Pulm Med. 2014;14:84.CrossRefPubMedPubMedCentral
30.
Ren J, Li B. The Functional Stability of FOXP3 and RORγt in Treg and Th17 and Their Therapeutic Applications. Adv Protein Chem Struct Biol. 2017;107:155–89.CrossRefPubMed
31.
Figueroa-Vega N, Alfonso-Pérez M, Benedicto I, Sánchez-Madrid F, González-Amaro R, Marazuela M. Increased circulating pro-inflammatory cytokines and Th17 lymphocytes in Hashimoto’s thyroiditis. J Clin Endocrinol Metab. 2010;95(2):953–62.CrossRefPubMed
32.
Horie I, Abiru N, Nagayama Y, Kuriya G, Saitoh O, Ichikawa T, Iwakura Y, Eguchi K. T helper type 17 immune response plays an indispensable role for development of iodine-induced autoimmune thyroiditis in nonobese diabetic-H2h4 mice. Endocrinology. 2009;150(11):5135–42.CrossRefPubMed
33.
Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, Grimley Evans J, Hasan DM, Rodgers H, Tunbridge F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995;43(1):55–68.CrossRefPubMed
34.
Resta O, Carratù P, Carpagnano GE, Maniscalco M, Di Gioia G, Lacedonia D, Giorgino R, De Pergola G. Influence of subclinical hypothyroidism and T4 treatment on the prevalence and severity of obstructive sleep apnoea syndrome (OSAS). J Endocrinol Invest. 2005;28(10):893–8.CrossRefPubMed
Metadata
Title
The association of lymphocyte with hypothyroidism in obstructive sleep apnea
Authors
Xiaoyan Fang
Le Wang
Chong Xu
Tuai Xue
Mingchu Zhang
Lingling Liu
Jie Cao
Jing Zhang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2024
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-024-02872-7

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