Effects of octreotide on sleep apnoea and tongue volume (magnetic resonance imaging) in patients with acromegaly

Abstract

Objectives: Sleep apnoea has been consistently reported to occur in acromegaly. Both obstructive apnoeas, in which apnoeas are due to intermittent obstruction of the upper airways, as well as central apnoeas are known to occur. Because the relationship between disease activity and severity of sleep apnoea is currently unclear, we have performed a prospective study to address this issue. Design and methods: In 14 newly diagnosed patients with active acromegaly (eight females and six males; mean age 57^4 years; IGF-I 583^48 mg/l; GH 13.5^7.0 mg/l (means^S.E.M.)), tongue volume and signal intensity of the tongue were examined by magnetic resonance imaging and sleep apnoea was characterised by polysomnography before and after 6 months of treatment with octreotide acetate (Sandostatin LAR 10 -30 mg every 4 weeks i.m.). Results: The initial tongue volume was significantly higher in patients with acromegaly (151^9 ml; females 133^10 ml; males 172^10 ml) in comparison with the body mass index (BMI)-and agematched healthy control group (97^5 ml, P , 0.001; females 75^1 ml, P , 0.001; males 120^3 ml, P , 0.003). After treatment with octreotide, IGF-I was normalised within the ageadjusted normal range in 50% of the patients. In these patients, tongue volume significantly decreased (120^14 ml, P , 0.05) in comparison with the persistent uncontrolled group of acromegalics (137^10 ml, P ¼ not significant). Overall, tongue volume (128^8 ml, P , 0.05) and the signal intensity ratio of the tongue decreased significantly after treatment with octreotide acetate (120^3 vs 105^3, P ¼ 0.003). The BMI-adjusted tongue volume correlated with IGF-I levels (r ¼ 0.60, P , 0.002) and the disease duration (r ¼ 0.71, P ¼ 0.006). At baseline, 50% had obstructive sleep apnoea with a mean respiratory disturbance index (RDI) of . 20/h (range 5.1-91.5) and no patient had central sleep apnoea. After 6 months of octreotide treatment, there was a 28^10% decrease in RDI. However, RDI did not correlate with IGF-I or GH levels, but correlated positively with BMI (r ¼ 0.58, P ¼ 0.001) and age (r ¼ 0.46, P ¼ 0.02). Conclusions: Obstructive sleep apnoea but not central sleep apnoea frequently occurs in patients with active acromegaly. Successful treatment with octreotide can decrease tongue volume, which may have benefits for coexisting sleep-disordered breathing.European Journal of Endocrinology 151 309-315

Prevalence of sleep apnea and metabolic abnormalities in patients with acromegaly and analysis of cephalometric parameters by magnetic resonance imaging.

“…In this series of patients with active acromegaly, we found an SA prevalence of 87.5% and an SAS prevalence of 75%, confirming previous reports from others studies (6,17,18). Only one patient (4.7%) had the central form of SA that was related to a severe left ventricular dysfunction and Cheyne-Stokes breathing episodes at PSG.…”

“…Other studies suggested that upper airway narrowing caused by changes in pharyngeal soft tissues may play a more relevant role in the development of OSA in acromegalic patients than skeletal anomalies (19,22,23). In addition to adenoid, uvular, and tonsilar hypertrophy, macroglossia also narrows pharyngeal airway space (18). MRI, compared with other imaging techniques, has the advantage of more precise delineation of soft tissue and determination of length and thickness of soft palate and tongue (18), which is why this method was adopted in our study.…”

“…In addition to adenoid, uvular, and tonsilar hypertrophy, macroglossia also narrows pharyngeal airway space (18). MRI, compared with other imaging techniques, has the advantage of more precise delineation of soft tissue and determination of length and thickness of soft palate and tongue (18), which is why this method was adopted in our study. Active acromegalic patients have increased tongue volumes by MRI (18).…”

“…MRI, compared with other imaging techniques, has the advantage of more precise delineation of soft tissue and determination of length and thickness of soft palate and tongue (18), which is why this method was adopted in our study. Active acromegalic patients have increased tongue volumes by MRI (18). Additionally, when compared with non-obstructive SA controls, patients with OSA had a higher length and area of soft palate; tongues that were not only more inferiorly positioned but also had more tongue tissue at the hypopharyngeal level; and pharyngeal airway spaces that had significantly reduced anteroposterior dimensions at the nasopharyngeal, oropharyngeal, and hypopharyngeal levels (24).…”

“…Despite the lack of definitive documentation, it is generally accepted that improvement of OSA is mediated through a decrease in upper airway obstruction, either by reduction of upper airway soft tissue bulk, and collapsibility, or by improvement of upper airway muscle function (18). Additionally, octreotide might have direct effects on respiratory control and upper airways that are unrelated to its action on the pituitary (18,19,(26)(27)(28).…”