From the Guidelines
Hemochromatosis should be considered a relevant comorbidity when evaluating a patient for obstructive sleep apnea (OSA) due to its potential to exacerbate or mimic OSA symptoms through iron deposition in respiratory muscles and the central nervous system. Patients with hemochromatosis experience iron overload, which can lead to deposition in multiple organs, including the respiratory muscles and central nervous system, potentially contributing to upper airway muscle dysfunction, reduced respiratory drive, and altered sleep architecture, all of which can exacerbate or mimic OSA symptoms 1. The presence of hemochromatosis may also influence treatment decisions for OSA, as addressing the underlying iron overload through phlebotomy or chelation therapy might improve some sleep-related symptoms. Furthermore, untreated OSA in hemochromatosis patients could potentially worsen cardiovascular complications already associated with iron overload. Key considerations in the evaluation of OSA in patients with hemochromatosis include:
- Iron deposition in respiratory muscles and the central nervous system
- Potential for upper airway muscle dysfunction and reduced respiratory drive
- Altered sleep architecture
- Compound symptoms of fatigue and daytime sleepiness
- Influence on treatment decisions for OSA
- Potential worsening of cardiovascular complications associated with iron overload.
From the Research
Evaluation of Hemochromatosis for OSA
To evaluate hemochromatosis for Obstructive Sleep Apnea (OSA), several factors should be considered:
- The relationship between OSA and hemostatic alterations, including hypercoagulability and inflammation, as discussed in 2
- The association between OSA and changes in hemocyte profile, such as elevated leukocytes, neutrophils, and hematocrit, as found in 3 and 4
- The potential for OSA to contribute to secondary erythrocytosis, although studies such as 5 suggest that this may not be a significant association
Justification for Evaluating Hemochromatosis in OSA Diagnosis
The following points justify evaluating hemochromatosis in the diagnosis of OSA:
- OSA has been linked to a hypercoagulable state, which may be related to hemostatic alterations, as discussed in 2
- Hematocrit levels have been found to be associated with OSA severity, as shown in 3 and 4
- Although the relationship between OSA and erythrocytosis is uncertain, evaluating hemochromatosis may help identify underlying conditions that contribute to OSA, as suggested in 5
Key Findings
Key findings from the studies include:
- OSA is associated with a hypercoagulable state, which may contribute to cardiovascular disease, as discussed in 2
- Hematocrit levels are significantly correlated with OSA severity, as found in 3 and 4
- The relationship between OSA and erythrocytosis is complex and may be influenced by factors such as hypoxemia, as suggested in 5