[A young man with adynamia, subepicardial ischemia and sleep apnea]

A 44-year-old manager presented himself for the assessment of nocturnal apnoea. He reported increasing lack of drive and nightly angina pectoris.

Polysomnography indicated obstructive apnoea and hypopnoea with a respiratory disturbance index of 29.1, while the ECG showed T wave inversion in all leads. There was severe hypothyroidism with atrophic thyroid tissue.

The patient had an obstructive sleep apnoea syndrome (OSAS), hypothyroidism with myxoedema, hypopnoea and myocardial ischaemia. He was treated with negative peak airway pressure (nCPAP) ventilation, administration of L-thyroxine and initiation of anti-anginal medication, which relieved his symptoms. The severe hypothyroidism was thought to be the most important cause of his respiratory disorder and angina.

This case illustrates the connection between hypothyroidism and OSAS. Hypothyroidism must be excluded in patients with OSAS, regardless of the patient's age.