Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease

Abstract

Background: Whether sleep apnoea syndrome (SAS) subsides after biochemical and clinical remission of acromegaly is controversial. Objective: To assess the presence of SAS in a cohort of acromegalic patients, which included a subgroup with active disease and a subgroup in remission, and to evaluate clinical and biochemical independent predictors of SAS. Design: Cross-sectional and longitudinal study. Setting: Italian university department of internal medicine. Patients: About 36 acromegalic patients: 18 active and 18 controlled. Measurements: Polysomnography was performed in all patients and repeated in six with active acromegaly and SAS after achieving disease control. Echocardiographic parameters were also measured. Results: The prevalence of SAS was 47% in the overall acromegalic population: 56% in the active group and 39% in the controlled one. In a multivariate analysis IGF1, male gender, age, body mass index, and disease duration were associated with SAS. Impaired glucose tolerance or diabetes was more prevalent in patients with SAS, particularly in the severe cases. Among the six patients of the longitudinal study, five showed improvement of SAS, but none recovered. No correlation was found between echocardiographic parameters and severity of SAS. Conclusion: SAS can persist after recovery of acromegaly in several patients. Given the negative prognostic significance of this respiratory disorder, polysomnography should be included as routine procedure in the work-up of the acromegaly, even if in remission, being mandatory in those patients considered at high risk (elderly males, overweight, diabetic). Appropriate intensive treatment should be implemented to minimize the clinical impact of SAS in acromegaly.

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

“…In the present study, we found a prevalence of sleep apnoea syndrome of 83% in patients with active acromegaly, confirming reports from previous studies (17,(24)(25)(26). Successful treatment via IGF1 normalization led to a 24% improvement of the AHI.…”

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

“…Different series have noted a relatively high prevalence (45-80 %), which is significantly higher than that of the general population (2-4 %) [1,2], although it is probably still under-assessed [3]. In this setting, a recent consensus on acromegaly complications stated that every patient should undergo a careful symptomatic [for example, with an Epworth Sleepiness scale score (ESS)] and/or laboratory assessment for SAS at the time of diagnosis, in collaboration with a respiratory physician [3].…”

“…For instance, some studies showed significant improvement after pituitary surgery [7] or somatostatin analogues [8,9], while others observed that SAS persisted after recovery of acromegaly in a relatively high percentage of patients, despite a potential association with IGF-I levels and disease duration [1]. In their longitudinal study, Castellani et al noted how active acromegalic patients who achieved biochemical control, regardless of how they did so (surgery, radiotherapy and/or medical therapy), experienced improvement of their sleep disorder.…”

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

“…The response of comorbidities to medical treatment and/ or their reversibility need to be individually assessed in a consistent manner (SR). [18][19][20][21][22][23] Biochemical results with drug treatment Three forms of medical therapy have been used in the treatment of acromegaly: two are receptor-based, directed at the pituitary adenoma (the somatostatin recep tor ligands [SRLs] octreotide and lanreotide, and the dopamine agonist cabergoline); and one is directed at decreasing and/or blocking GH effects in the periphery (the GH receptor antagonist [GHRA] pegvisomant).…”