A young man with reduced muscle power, subepicardial ischaemia and sleep apnoea

History and clinical findings: A 44-year-old manager presented himself for the assessment of nocturnal apnoea. He reported increasing lack of drive an d nightly angina pectoris. Investigations: Polysomnography indicated obstructive apnoea and hypopnoea with a respiratory disturbance index of 29.1, while the ECG showed T wave i nversion in all leads. There was severe hypothyroidism with atrophic thyroi d tissue. Diagnosis, treatment and course: The patient had an obstructive sleep apnoe a syndrome (OSAS), hypothyroidism with myxoedema, hypopnoea and myocardial ischaemia. He was treated with negative peak airway pressure (nCPAP) ventil ation, administration of L-thyroxine and initiation of anti-anginal medicat ion, which relieved his symptoms. The severe hypothyroidism was thought to be the most important cause of his respiratory disorder and angina. Conclusion: This case illustrates the connection between hypothyroidism and OSAS. Hypothyroidism must be excluded in patients with OSAS, regardless of the patient's age.