Open Access
CC BY-NC-ND 4.0 · Sleep Sci 2024; 17(S 01): S1-S89
DOI: 10.1055/s-0045-1811891
Sleep Science Supplement 2024

The Hypothalamic-Pituitary-Adrenal Axis and the Upper Airway: The Role of Cushing's Syndrome in Obstructive Sleep Apnea - A Systematic Review

Authors

  • Brenda Sousa Américo

    1   Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil

  • Letícia Guimarães Lopes

    1   Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil

  • Luísa Fontainha Rebouças

    1   Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil

  • Kenzo Ogasawara Donato

    1   Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil

  • Cristina Salles

    1   Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
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    Keywords

    cushing's - syndrome - obstructive sleep apnea - systematic review

    Introduction: Cushing's Syndrome (CS) is a metabolic disorder characterized by excessive cortisol production and impairment of the hypothalamic-pituitary-adrenal axis. Prolonged use of corticoids or the presence of an adrenal tumor are possible causes. Obstructive sleep apnea (OSA), in turn, is a condition involving multiple episodes of partial or complete occlusion of the upper airway during sleep, characterized by a period of apnea or hypopnea > 10 seconds. Individuals who have developed CS are more likely to develop comorbidities such as obesity, which is one of the predisposing causes of OSA.

    Objective: To evaluate the role of Cushing's Syndrome in Obstructive Sleep Apnea.

    Methods: A search was carried out in the PubMed, EMBASE, and Cochrane Library databases using the terms listed in DeCS/MeSH: “Cushing's syndrome” and “Obstructive sleep apnea”. The inclusion criteria were studies evaluating the association between Cushing's Syndrome and the development of obstructive sleep apnea in clinical trials or cross-sectional studies. The PRISMA protocol was used as a guide for the systematic review.

    Results: A total of 44 articles were found, of which 3 were included. Among the 57 individuals studied by Sevda et al., 17 had ACTH-secreting pituitary adenoma, 17 had adrenal CS, and 23 were control group participants aged similarly. The authors found that 47.1% of patients with CS had OSA (AHI ≥ 5) versus 17.4% of the control group. In a study comprising 3,224 participants, half of whom had CS, Wang et al. showed that when both groups were evaluated prospectively, individuals with CS had a 2.82 times greater risk of developing OSA than the control group (HR = 2.82; 95% CI: 1.67-4.77). Feyzi G. et al., in a study involving 60 participants (30 with CS and 30 in the control group), concluded that the prevalence of OSA is higher in CS patients than in the control group.

    Conclusion: Individuals diagnosed with Cushing's Syndrome are at least 2 times more likely also to be diagnosed with obstructive sleep apnea. These findings highlight the importance of early investigation of obstructive sleep apnea in patients presenting Cushing's Syndrome, demonstrating the significant role of the Hypothalamic-Pituitary-Adrenal Axis in Obstructive Sleep Apnea.


     

    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    16 September 2025

    © 2025. Brazilian Sleep Academy. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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