Obstructive Sleep Apnea in Acromegaly and the Effect of Treatment: A Systematic Review and Meta-Analysis

Abstract

Background Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway collapse requiring nocturnal ventilatory assistance. Multiple studies have investigated the relationship between acromegaly and OSA, reporting discordant results. Aim To conduct a meta-analysis on the risk for OSA in acromegaly, and in particular to assess the role of disease activity and the effect of treatments. Methods and Study Selection A search through literature databases retrieved 21 articles for a total of 24 studies (n = 734). Selected outcomes were OSA prevalence and apnea-hypopnea index (AHI) in studies comparing acromegalic patients with active (ACT) vs inactive (INACT) disease and pretreatment and posttreatment measures. Factors used for moderator and meta-regression analysis included the percentage of patients with severe OSA, patient sex, age, body mass index, levels of insulin-like growth factor 1, disease duration and follow-up, and therapy. Results OSA prevalence was similar in patients with acromegaly who had ACT and INACT disease (ES = −0.16; 95% CI, −0.47 to 0.15; number of studies [k] = 10; P = 0.32). In addition, AHI was similar in ACT and INACT acromegaly patients (ES = −0.03; 95% CI, −0.49 to 0.43; k = 6; P = 0.89). When AHI was compared before and after treatment in patients with acromegaly (median follow-up of 6 months), a significant improvement was observed after treatment (ES = −0.36; 95% CI, −0.49 to −0.23; k = 10; P < 0.0001). In moderator analysis, the percentage of patients with severe OSA in the populations significantly influenced the difference in OSA prevalence (P = 0.038) and AHI (P = 0.04) in ACT vs INACT patients. Conclusion Prevalence of OSA and AHI is similar in ACT and INACT patients in cross-sectional studies. However, when AHI was measured longitudinally before and after treatment, a significant improvement was observed after treatment.

A Pituitary Society update to acromegaly management guidelines

“…Improved biochemical control is also associated with a reduction in obstructive sleep apnea (OSA) and apnea-hypopnea index (AHI) assessed by polysomnography. A metaanalysis [30] that included 24 studies (n = 734) showed significant AHI improvement after medical or surgical treatment (effect size − 0.36; 95% CI − 0.49, − 0.23; p < 0.001), and another study of 27 patients [31] showed that 69% of patients with OSA at baseline were cured after achieving acromegaly disease control.…”

Prevalence of Sleep-Related Disordered Breathing among Acromegaly Patients and its Correlation to Cephalometric Parameters: An Indian Perspective

“…The mode of imaging used was also different in the various studies. van Haute et al 3 and Castellani et al 16 used MRI for image acquisition, while Ip et al and Parolin et al 8,18 and Sesmilo et al 17 used computed tomography and teleradiography, respectively. This is the first data on acromegaly and SRBD among Indian subjects although there are several limitations.…”

“…[3][4][5][6][7] OSA is present in up to 90% of patients with active acromegaly and is attributed to changes in soft, cartilaginous, and bony tissues at the level of craniofacial, pharyngeal, and laryngeal structures leading to obstruction of the airflow. [8][9][10][11][12] In addition to the adenoid, uvular, and tonsillar hypertrophy, macroglossia also narrows pharyngeal airway space in acromegaly [8][9][10][11][12] causing air inflow impediment. Data on acromegaly from India are scanty with a single study on a cohort of 271 acromegalic subjects reporting prevalence a of 10.3%, based on clinical questionnaire, with no comment on SRBD.…”

Towards an Earlier Diagnosis of Acromegaly and Gigantism

“…Another example is the presence of obstructive sleep apnea (OSA), which is a common disorder characterized by upper airway collapse requiring nocturnal ventilatory assistance [ 12 ]. Multiple studies have investigated the relationship between acromegaly and OSA, reporting discordant results.…”