Transsphenoidal pituitary surgery effects on obstructive sleep apnea in patients with acromegaly: a systematic review and meta-analysis

Abstract

Context: Acromegaly is a chronic disease associated with excessive growth hormone (GH) and insulin-like growth factor secretion, most commonly as a result of a pituitary adenoma. Patients diagnosed with acromegaly have a high incidence of obstructive sleep apnea. The introduction of endoscopic transnasal transphenoidal pituitary surgery has significantly decreased the risks and morbidities. It remains unclear, however, whether directed pituitary surgery has a significant long-term effect in reducing OSA indices among this population of patients.Objective: To assess whether treatment of acromegaly by means of endoscopic transnasal transphenoidal excision of pituitary adenoma has any significant longterm effects on the hypopnea index and oxygen desaturation index among patients with acromegaly and a co-morbid diagnosis of OSA. Our primary outcome was to evaluate the pre-and post-surgical values for AHI, and our secondary outcomes were the evaluation of GH, ODI, and IGF-1 values.Methods: In a systematic review and meta-analysis, studies relating to transsphenoidal pituitary adenomectomy in acromegalic patients with obstructive sleep apnea were extracted and analysed based on the inclusion criteria. A search was performed on Scopus, MED-LINE, Pubmed and The Cochrane Library, initially September 3 2015, with an update on October 10, 2015. The effect of the endoscopic transnasal transphenoidal surgery on primary and secondary outcomes was evaluated by metaanalysis.Results: Three studies (16 patients) were included. The mean age was 46.6±10.7 years old and a body mass index (BMI) of 28.7±2.4kg/m2. Our meta-analysis showed significant surgical treatment effect for AHI (p=0.0003) and IGF-1 (p<0.0001). One study reported GH values, which significantly improved following TSS (p<0.05). No studies included ODI. Each study analysed the results on different amount of time after TSS surgery. Levels of AHI and IGF-1 were significant lower when compared to to the pre-op. same for the conclusion. Conclusion:The Transsphenoidal surgery could be an option for selected patients to treat acromegaly with good results. Included studies reported an improvement on OSAS following TSS and hormonal control some months after the procedures.