Influence of disease control with pegvisomant on sleep apnoea and tongue volume in patients with active acromegaly

Abstract

Objectives: Sleep apnoea has been consistently reported to occur in acromegaly. In uncontrolled patients, the severity of sleep apnoea influences physical activity in the daytime. We investigated the influence of disease activity on tongue volume and sleep apnoea treated with the GH receptor antagonist pegvisomant in poorly controlled patients with acromegaly under octreotide. Design and methods: A total of 12 patients with active acromegaly (six females; six males; mean age 57G15 years; body mass index 29.4G4.2 kg/m 2 ; meanGS.D.) were treated with pegvisomant (13.5G5.0 mg/die) for 6 months. Tongue volume was examined by magnetic resonance imaging, and sleep apnoea was characterized by polysomnography before and after 6 months of treatment with pegvisomant. The mandibular length was determined by lateral X-ray films. Results: IGF1 levels decreased after 6 months in all patients (407G114 to 199G23 mg/l; PZ0.0001). The tongue volume decreased (105G33 to 83G33 ml; PZ0.007) as well as the apnoea-hypnoea index (23G22 to 18G18/h; PZ0.0066). The mandibular length correlated with the initial tongue volume (r 2 Z0.6072, PZ0.0028). Conclusion: In conclusion, successful treatment with pegvisomant can decrease tongue volume, which has benefits for coexisting sleep disordered breathing.

Expert consensus document: A consensus on the medical treatment of acromegaly

“…Pharmacological treatment of acromegaly improves left ventricular hypertrophy and dysfunction (HQ), hypertension (LQ), and obstructive sleep apnoea (MQ). [40][41][42][43][44] However, pharmacological treatment of acromegaly might not improve arthropathy (LQ), and effects on soft-tissue tumours are unknown. New techniques are needed to measure bone and joint integrity to assess better the effects of acromegaly treatment (MQ).…”

Obstructive Sleep Apnea Syndrome Is Less Frequent in Patients With Well-Controlled Acromegaly Treated With Somatostatin Analogues, Pegvisomant or in Combination

“…It has been shown that treatment with octreotide can reduce sleep apnea indices (respiratory disturbance index (RDI)) and tongue volume [3,16]. The same observations could be documented with pegvisomant [8]. The effect of treatment with SSA, pegvisomant and dopaminergic agonists is the result of IGF-I and/or GH-normalization with the consequence of reduced soft tissue swelling of the uvula and the tongue volume, which has a major impact of OSA [17].…”

“…Successful treatments by surgery and with SSA, pegvisomant or in combination improved sleep apneas syndrome [3,8,11,15]. It has been shown that treatment with octreotide can reduce sleep apnea indices (respiratory disturbance index (RDI)) and tongue volume [3,16].…”

“…After sufficient treatment with somatostatin analogues (SSA), pegvisomant or successful resection of the GH-producing adenoma after transsphenoidal surgery, parameters and prevalence of OSA significantly reduced [3,8].…”

Clinical features of sleep-related breathing disorders in patients with acromegaly

“…Согласно данным различных исследователей при АМ чаще встречается ОАС [19,22,23]. Кроме указаний на более высокую распро-страненность ОАС среди пациентов с АМ, в литературе отсутствуют данные о других особенностях клинического течения ОАС у больных АМ по сравнению с пациентами с ОАС без этого заболевания.…”