Effect of Sandostatin^® LAR^® on sleep apnoea in acromegaly: correlation with computerized tomographic cephalometry and hormonal activity

Abstract

The findings demonstrated that there was correlation between sleep apnoea severity and soft tissue overgrowth at the upper airway region in acromegaly. They also suggest that Sandostatin LAR improved obstructive sleep apnoea in acromegaly, and the effect might be partly mediated via a reduction in upper airway soft tissue, in particular that of the tongue, concomitant with a reduction in GH levels.

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

“…Although it has previously been described that patients with the central form of SA have significantly higher GH and IGF-I levels than those with obstructive disease (6), in this patient GH and IGF-I levels were lower than the respective maximum levels of the group. Also, we confirmed previous reports that suggested OSA to be the most prevalent form of sleep-disordered breathing in acromegaly (95.3%, nZ21) (2,6,19). Several anatomical skeletal abnormalities that predispose to OSA, such as dorsocaudal rotation of the mandible, increase in facial height, and narrowing of the depth of the bony framework of the nasopharynx, have been identified in patients with acromegaly (20)(21)(22).…”

“…Several anatomical skeletal abnormalities that predispose to OSA, such as dorsocaudal rotation of the mandible, increase in facial height, and narrowing of the depth of the bony framework of the nasopharynx, have been identified in patients with acromegaly (20)(21)(22). 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).…”

“…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).…”

Somatostatin agonists for treatment of acromegaly

“…The apnea-hypopnea index improved in 55% and snoring episodes were reduced in 66% of patients (Ip et al, 2001). …”

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

“…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.…”