Prevalence of obstructive sleep apnea in patients with prolactinoma before and after treatment with dopamine agonists

Barbosa, Flávia Regina; Silva, Cintia Marques dos Santos; Lima, Giovanna A B; Warszawski, Leila; Domingues, Romeu Côrtes; Dominic, Michele; Fontes, Rosita; Neto, Leonardo Vieira; Gadelha, Mônica R.

doi:10.1007/s11102-013-0524-y

Cited by 27 publications

(36 citation statements)

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confidence: 99%

“…Obstructive sleep apnea (OSA) is a common comorbid condition in various skull base tumors, including functioning pituitary adenomas . Among the functioning pituitary adenomas, 34% and 46% of patients with prolactinoma and corticotropinoma were found to have OSA, respectively . Hormonal irregularities associated with functioning pituitary tumors contribute to obesity in some patients, putting them at risk for OSA …”

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confidence: 99%

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Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model

Chitguppi

Rimmer

Garcia

et al. 2019

Int Forum Allergy Rhinol

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Background: Although recent guidelines for obstructive sleep apnea recommend early postoperative use of continuous positive airway pressure (CPAP) a er endonasal skull base surgery, the time of initiation of CPAP is unclear. In this study we used a novel, previously validated cadaveric model to analyze the pressures delivered to the cranial base and evaluate the effectiveness of various repair techniques to withstand positive pressure. Methods:Skull base defects were surgically created in 3 fresh human cadaver heads and repaired using 3 commonly used repair techniques: (1) Surgicel TM onlay; (2) dural substitute underlay with dural sealant onlay; and (3) dural substitute underlay with nasoseptal flap onlay with dural sealant. Pressure microsensors were placed in the sphenoid sinus and sella, both proximal and distal to the repair, respectively. The effectiveness of each repair technique against various CPAP pressure se ings (5-20 cm H 2 O) was analyzed.Results: Approximately 79%-95% of positive pressure administered reached the sphenoid sinus. Sellar pressure levels varied significantly across the 3 repair techniques and were lowest a er the third technique. "Breach" points (CPAP se ings at which sellar repair was violated) were lowest for the first group. All 3 specimens showed a breach a er the first repair technique. For the second repair technique, only a single breach was created in 1 specimen at 20 cm H 2 O. No breaches were created in the third group. Conclusion: Different skull base repair techniques have varying ability to withstand CPAP. Both second and third repair techniques performed in a nearly similar fashion with regard to their ability to withstand positive pressure ventilation. C 2019 ARS-AAOA, LLC. How to Cite this Article: Chitguppi C, Rimmer RA, Garcia HG, et al. Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model. Int Forum Allergy Rhinol. 2019;9:795-803.

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confidence: 99%

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confidence: 99%

Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model

Chitguppi

Rimmer

Garcia

et al. 2019

Int Forum Allergy Rhinol

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“…This is consistent with the reported range in the literature for endoscopic CSF leak rates which varies from 0.5 to 14%. 1,4,8,11,12,[18][19][20]26,30,45 This suggests that patients with OSA are at minimally increased risk of leak compared with their unaffected counterparts. This may be due to greater use of advanced closure methods in this population; however, this was not reviewed in our study.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] OSA has also been established as an independent risk factor for spontaneous CSF leak. [14][15][16][17][18][19][20] OSA causes cerebral vasodilation due to periods of hypercapnia, which results in increased ICP, a phenomenon also found in OSA patients while awake. 16 The mainstay of treatment for OSA is positive pressure ventilation (PPV), usually in the form of continuous positive airway pressure (CPAP).…”

Section: Introductionmentioning

confidence: 94%

Timing of Postoperative CSF Leak after Endoscopic Skull Base Surgery in Patients with Obstructive Sleep Apnea

et al. 2018

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Background There is little data regarding postoperative outcomes of patients with obstructive sleep apnea (OSA) undergoing skull base surgery. The purpose of this study is to determine an association between risk factors and proximity of cerebrospinal fluid (CSF) leak to surgery in patients with OSA undergoing endoscopic skull base surgery. Methods A retrospective review of neurosurgical inpatients, with and without OSA, at a tertiary care institution from 2002 to 2015 that experienced a postoperative CSF leak after undergoing endoscopic skull base surgery. Results Forty patients met inclusion criteria, 12 (30%) with OSA. OSA patients had significantly higher body mass index (BMI; median 39.4 vs. 31.7, p < 0.01) and were more likely to have diabetes (41.7 vs. 10.7%, p = 0.04) than non-OSA patients; otherwise there were no significant differences in clinical comorbidities. No patients restarted positive pressure ventilation (PPV) in the inpatient setting. The type of repair was not a significant predictor of the time from surgery to leak. Patients with OSA experienced postoperative CSF leak 49% sooner than non-OSA patients (Hazard Ratio 1.49, median 2 vs. 6 days, log-rank p = 0.20). Conclusion Patients with OSA trended toward leaking earlier than those without OSA, and no OSA patients repaired with a nasoseptal flap (NSF) had a leak after postoperative day 5. Due to a small sample size this trend did not reach significance. Future studies will help to determine the appropriate timing for restarting PPV in this high risk population. This is important given PPV's significant benefit to the patient's overall health and its ability to lower intracranial pressure.

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“…Moreover, lifestyle changes, including daily physical activity, improved sleep hygiene, and dietary adjustments improve not only metabolic syndrome, but also OSAS, especially in obese patients [6]. In obese subjects with prolactinoma, Barbosa et al described that OSAS prevalence is similar to the obese controls: weight and visceral obesity (and not prolactin levels) were the major factor involved in the occurrence of sleep disorders, indeed OSAS symptoms did not improve after dopamine-agonist treatment [18]. Although adenotonsillar hypertrophy emerges as one of the major contributing factors to OSAS in children and adolescences than in adults, recently some authors reported that even obesity plays an important contributory role to the pathophysiology of OSAS in young subjects [19].…”

Section: The Round Trip Between Osas and Metabolic Syndromementioning

confidence: 99%

Sleep apnea syndrome in endocrine clinics

Ceccato

Bernkopf²,

Scaroni

2015

J Endocrinol Invest

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Obstructive sleep apnea syndrome (OSAS) is a chronic condition with a high prevalence (up to 7 % of the general population) characterized by frequent episodes of upper airway collapse while sleeping. Left untreated, OSAS can cause severe complications, including systemic hypertension, cardiovascular disease, stroke, and abnormal glucose metabolism. This review aims to summarize the close links between OSAS, endocrinology, and metabolism. In patients with metabolic syndrome, OSAS is an independent risk factor for the onset of type 2 diabetes and a worsening glycemic control. The accumulation of adipose tissue in the neck and limited chest wall dynamics, hypoxia, and local micro-inflammation link visceral obesity closely with OSAS. There is now an abundance of convincing data indicating that promoting lifestyle changes, improving sleep hygiene, and adjusting diet can ameliorate both metabolic syndrome and OSAS, especially in obese patients. The incidence of OSAS in acromegaly is high, though GH treatments seem to be unrelated to the onset of apnea in GH-deficient individuals. Prospective studies have suggested an association between hypertension and OSAS because intermittent nocturnal hypoxia prompts an increase in sympathetic tone, endothelial dysfunction, and vascular inflammation: aldosterone excess may have a pathophysiological role, and some authors have reported that treating OSAS leads to a modest, but significant, reduction in blood pressure.

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Prevalence of obstructive sleep apnea in patients with prolactinoma before and after treatment with dopamine agonists

Abstract: The OSA prevalence in patients with prolactinoma is similar to the obese subjects and did not change after treatment. Higher BMI and visceral obesity, but not prolactin levels, seem to be the major factor involved in the occurrence of OSA in these patients.

Cited by 27 publications

References 27 publications

Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model

Evaluation of cranial base repair techniques utilizing a novel cadaveric CPAP model

Timing of Postoperative CSF Leak after Endoscopic Skull Base Surgery in Patients with Obstructive Sleep Apnea

Sleep apnea syndrome in endocrine clinics

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