Sleep apnea syndrome in acromegalic patients: Can morphological evaluation guide us to optimize treatment?

Ramos-Leví, Ana M.; Marazuela, Mónica

doi:10.1007/s12020-015-0787-3

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…Since neither the diameter, width, or volume of the PA (RA, OA, and HA) differed between patients with acromegaly and controls (Table ), our findings indicate the difficulty in predicting airway obstruction from the PA structure as shown on CT images without estimating airflow pressure in patients with acromegaly (Table , Fig. ) as discussed previously . Additionally, the volume of the tongue was larger in patients with acromegaly (Table ) and correlated with minimum postoperative SpO 2 (Fig.…”

Section: Discussionsupporting

confidence: 53%

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Evaluation of the pharyngeal airway using computational fluid dynamics in patients with acromegaly

Mukaihara

Hasegawa-Moriyama

Iwasaki

et al. 2018

Laryngoscope Investig Oto

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ObjectivesPerioperative airway management may be particularly challenging in patients with acromegaly undergoing trans‐sphenoidal pituitary surgery (TSS). Management for airway obstruction is required prior to pituitary surgery to minimize perioperative hypoxia. The purpose of this retrospective study was to evaluate airway obstruction by simulation of computational fluid dynamics (CFD) using computed tomography (CT) images in patients who had undergone TSS.MethodsCT images of the nasopharyngeal airways of patients with acromegaly (n = 5) or nonfunctional pituitary adenoma (n = 6) undergoing TSS from April 2012 to January 2017 were used to construct these airways in three dimensions. Estimated airflow pressure and velocity in the retropalatal airway (RA), oropharyngeal airway (OA), and hypopharyngeal airway (HA) were simulated using CFD.ResultsEstimated pharyngeal airflow pressure in the HA, OA, and RA was significantly greater in patients with acromegaly than in those with nonfunctional pituitary adenomas whereas the estimated pharyngeal airflow velocity was significantly impaired only in the RA of patients with acromegaly. Minimum postoperative SpO2 both within 3 hours and from 3 to 12 hours after the end of anesthesia was significantly lower in the patients with acromegaly. Additionally, estimated volume of tongue and pharyngeal airflow pressure in the HA, OA, and RA correlated with minimum postoperative SpO2.ConclusionPharyngeal airflow pressure estimated from CT images is high in patients with acromegaly, and these values correlate with postoperative minimum values for SpO2. Preoperative evaluation of CT images by CFD can predict difficulty in airway management and perioperative hypoxia.Level of Evidence4.

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Section: Discussionsupporting

confidence: 53%

“…2) as discussed previously. 15 Additionally, the volume of the tongue was larger in patients with acromegaly (Table II) and correlated with minimum postoperative SpO 2 (Fig. 2).…”

Section: Discussionmentioning

confidence: 81%

Evaluation of the pharyngeal airway using computational fluid dynamics in patients with acromegaly

Mukaihara

Hasegawa-Moriyama

Iwasaki

et al. 2018

Laryngoscope Investig Oto

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“…Obstructive sleep apnea is the most common sleep disorder in patients with acromegaly, and also specifically associated with increased mortality (89, 90, 92, 99). The prevalence of sleep apnea in acromegaly ranges from 45 to 80% and does not reliably relate to disease activity, with conflicting studies on its reversibility following successful treatment of acromegaly (92, 107).…”

Section: Role Of Insulin-resistance In the Development Of Acromegaly-mentioning

confidence: 99%

Insulin Resistance in Patients With Acromegaly

et al. 2019

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Acromegaly is characterized by chronic overproduction of growth hormone (GH) that leads to insulin resistance, glucose intolerance and, ultimately, diabetes. The GH-induced sustained stimulation of lipolysis plays a major role not only in the development of insulin resistance and prediabetes/diabetes, but also in the reduction of lipid accumulation, making acromegaly a unique case of severe insulin resistance in the presence of reduced body fat. In the present review, we elucidate the effects of GH hypersecretion on metabolic organs, describing the pathophysiology of impaired glucose tolerance in acromegaly, as well as the impact of acromegaly-specific therapies on glucose metabolism. In addition, we highlight the role of insulin resistance in the development of acromegaly-associated complications such as hypertension, cardiac disease, sleep apnea, polycystic ovaries, bone disease, and cancer. Taken together, insulin resistance is an important metabolic hallmark of acromegaly, which is strongly related to disease activity, the development of comorbidities, and might even impact the response to drugs used in the treatment of acromegaly.

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“…In the study of Hernandez - Gordillo et al including 35 acromegalics with the mean age of 51 (39-63), the mean AHI was found to be 34 events/hour, and the mean BMI was 29 kg/m. 2 Although they reported a slightly older group of patients with higher AHI than our cohort, they did not refer to any age-AHI-related results. 16 …”

Section: Discussionmentioning

confidence: 54%

“…According to AACE 2011 update, the frequency of sleep apnea is approximately 70% in acromegaly with no sleep disturbances-related symptoms and more than 90% who is snoring. 1 The craniofacial anomalies including hyperplasia of the mandible, increased length and thickness of the uvula, 2 , 3 macroglossia, and thickening of the laryngeal wall with increased soft tissue lead to obstructive sleep apnea (OSA) in acromegaly patients. 1 , 4 Besides, the inhibition of the respiratory center, probably due to the elevated levels of GH, may cause central sleep apnea.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Acromegaly patients with sleep disturbance related symptoms

Çelik¹,

Duyar²,

Aksu³

et al. 2021

Pak J Med Sci

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Background and Objectives: It is known that the prevalence of obstructive sleep apnea (OSA) is increased in acromegaly. Craniofacial anomalies, macroglossia, and thickening of the laryngeal wall caused by the increase in soft tissue in these patients lead to OSA. Also, the increase in growth hormone can trigger central apnea by causing a decrease in respiratory drive. Determining the polysomnographic characteristics of acromegaly patients is important to reveal the effect of these mechanisms. Methods: The demographic and polysomnographic characteristics of 33 acromegaly patients who underwent polysomnography (PSG) with suspicion of sleep disorders between 2011 and 2018 in the sleep laboratory of our hospital were retrospectively analyzed. One of the patients was excluded from the analysis because PSG was performed in the postoperative period. The remaining 32 patients with active acromegaly were grouped according to their gender and the presence of OSA and compared with statistical methods in terms of polysomnographic and clinical features. Results: OSA (AHI>5) was detected in 78.1% of 32 active acromegaly patients (18 females, 14 males) who underwent PSG with suspicion of sleep-disordered breathing. Moderate-severe OSA (62.5%) was found in most patients, and there was no difference between the sexes in terms of OSA detection rate and OSA severity. Respiratory events appear to be predominantly obstructive hypopneas. Also, the polysomnographic features of female and male acromegaly patients with OSA were found to be similar. It is seen that the OSA group is similar to the group with simple snoring in terms of body mass index (BMI), but is statistically significantly older (p=0,007). A positive correlation was found between age and AHI in pairwise correlation analysis (r:0,426 p:0,015, respectively). Conclusion: Considering that the prevalence of OSA in the population is approximately 5%, our results show that the risk of OSA in acromegaly increases, and obstructive pathways are effective in this increase. The probability of OSA occurrence and polysomnographic features between the genders are similar. Although the median BMI of the patients with and without OSA was similar, the median age was higher in the group with OSA, middle-aged acromegaly patients should be evaluated in terms of OSA even if there is no obvious obesity. doi: https://doi.org/10.12669/pjms.37.4.4229 How to cite this:Celik D, Duyar SS, Aksu F, Firat S, Ciftci B. Evaluation of Acromegaly patients with sleep disturbance related symptoms. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.4229 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Sleep apnea syndrome in acromegalic patients: Can morphological evaluation guide us to optimize treatment?

Cited by 5 publications

References 11 publications

Evaluation of the pharyngeal airway using computational fluid dynamics in patients with acromegaly

Evaluation of the pharyngeal airway using computational fluid dynamics in patients with acromegaly

Insulin Resistance in Patients With Acromegaly

Evaluation of Acromegaly patients with sleep disturbance related symptoms

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