From the Guidelines
Coronary artery disease (CAD) increases the risk of obstructive sleep apnea (OSA) in this patient. The patient's medical history and physical examination suggest a high risk for OSA, and CAD is a significant factor that contributes to this risk. According to the 2016 European guidelines on cardiovascular disease prevention in clinical practice 1, there is evidence of a positive relationship between obstructive sleep apnoea syndrome (OSAS) and hypertension, CAD, atrial fibrillation (AF), stroke, and HF. This suggests that CAD is closely linked to the development of OSA.
While hypothyroidism, generalized anxiety disorder (GAD), nonalcoholic fatty liver disease (NAFLD), and osteoporosis are all significant health conditions, the direct relationship between these conditions and OSA is not as strongly established as it is with CAD. Some key points to consider in this patient's case include:
- The patient's symptoms of excessive daytime sleepiness and loud snoring, which are classic indicators of OSA
- The physical examination finding of narrowing of the oropharynx due to excessive soft tissue, which can contribute to upper airway obstruction during sleep
- The patient's medical history of CAD, which is a known risk factor for OSA, as stated in the guidelines 1.
Overall, CAD is the condition in the patient's history that increases her risk of OSA, and further evaluation and management of OSA should be considered to reduce the risk of cardiovascular morbidity and mortality.
From the Research
Conditions Increasing the Risk of Obstructive Sleep Apnea (OSA)
The patient's history includes several conditions that could potentially increase her risk of obstructive sleep apnea (OSA). These conditions are:
- Coronary artery disease (CAD)
- Generalized anxiety disorder (GAD)
- Hypothyroidism
- Nonalcoholic fatty liver disease (NAFLD)
- Osteoporosis
Relevant Conditions
Based on the provided evidence, the condition that increases the risk of OSA in this patient is:
Evidence Supporting Hypothyroidism as a Risk Factor
- A study published in 1988 found that thyroid deficiency states are a well-recognized cause of the sleep apnea syndrome, and that thyroid hormone replacement can diminish or completely eliminate apneic episodes and arterial oxygen desaturation 2.
- A 2022 study found that the prevalence of OSA is quite high in hypothyroidism, and that patients with hypothyroidism should be screened for OSA for early diagnosis, especially in individuals with higher BMI 3.
- A 2024 bidirectional 2-sample Mendelian randomization study found that hypothyroidism could increase the risk of developing OSA, but did not provide evidence to support a causal relationship of OSA on hypothyroidism 4.
- Although a 2013 study did not find a significant relationship between OSA and thyroid disease, other studies suggest a link between hypothyroidism and OSA 5.
Other Conditions
While the other conditions listed (CAD, GAD, NAFLD, and osteoporosis) may have some association with sleep disturbances or other health issues, the evidence provided does not directly support them as increasing the risk of OSA in this patient, compared to the strong evidence supporting hypothyroidism as a risk factor 6.