Prevalence of the sleep apnea syndrome in acromegaly population

Weiss, V; Šonka, Karel; Pretl, Martin; Dostálová, Simona; Klozar, Jan; Rambousek, Petr; Jakóbisiak, Marek; Haas, T

doi:10.1007/bf03343767

Cited by 80 publications

(57 citation statements)

References 17 publications

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“…As in previous studies, predictive criteria in our patients were male gender (5, 7, 11), long duration of disease before diagnosis (i.e. R6 years), and large neck circumference (26,27). The preponderance of men with SAS resembles the trend in nonacromegalic patients.…”

Section: Discussionsupporting

confidence: 73%

Effect of transsphenoidal surgery on sleep apnoea in acromegaly

Sze

Schmid²,

Bloch³

et al. 2007

eur j endocrinol

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Objective: Sleep apnoea syndrome (SAS) is common in acromegaly and both diseases are independently associated with hypertension and insulin resistance contributing to increased morbidity and mortality. Pituitary surgery remains the principal treatment modality in acromegaly. The aim of this study was to assess the prevalence and risk factors of SAS in acromegaly and to analyze the effect of transsphenoidal adenomectomy on SAS and cardiovascular risk factors. Subjects and methods: Thirteen consecutive patients (seven women and six men, aged 25-77 years) with newly diagnosed acromegaly were prospectively studied. Biochemical assessment (IGF-I, GH, acid labile subunit, fasting blood glucose (FBG), insulin), overnight respiratory polygraphy, and an Epworth Sleepiness scale score (ESS) were obtained before and 12 weeks after surgery. SAS was defined by an ESS R10 and R5 apnoeas/hypopnoeas (central or obstructive) per hour. Results: Six of the thirteen (46%) patients had SAS. Risk factors were male gender (83.3 vs 14.3% without SAS) and long disease duration until diagnosis of acromegaly (10.2G3.2 vs 4.6G3.6 years, meanGS.D.). Ten patients had a homeostasis assessment model score R4 indicating insulin resistance and one had diabetes mellitus requiring insulin. Seven patients had hypertension (R140/90 mmHg). Postoperatively, GH and IGF-I levels decreased, but only five patients were cured. However, SAS resolved in all patients irrespective of whether acromegaly was cured or not. FBG (5.5G1.2 vs 4.8G0.4 mmol/l) and systolic blood pressure (150.8G18.5 vs 130.8G17.5 mmHg) decreased in all SAS patients. Conclusion: We found a high prevalence of SAS in acromegaly patients, in particular, in men and those with long duration of disease. Importantly, a marked reduction of GH excess by transsphenoidal adenomectomy may cure SAS and improve insulin resistance and hypertension.European Journal of Endocrinology 156 321-329

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Section: Discussionsupporting

confidence: 73%

Effect of transsphenoidal surgery on sleep apnoea in acromegaly

Sze

Schmid²,

Bloch³

et al. 2007

eur j endocrinol

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“…Diabetes mellitus is more prevalent in acromegaly than in the general population, greater in the Spanish acromegalic population (especially in those exposed to somatostatin analogues) than in New Zealand (20%) (4), but lower than in Canada (40% plus 22% glucose intolerance) (11). The sleep apnoea syndrome reportedly affects between 67% and 75% of acromegalic patients when investigated prospectively (29,30). This is much greater than the prevalence of 13% observed in our registry and presumably reflects a low awareness of the problem by many physicians, who do not specifically ask about snoring and sleep apnoea in all their acromegalic patients.…”

Section: Morbiditymentioning

confidence: 99%

Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA)

Mestrón

Webb

Astorga

et al. 2004

European Journal of Endocrinology

351

232

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Objective: To undertake a multicentre epidemiological study reflecting acromegaly in Spain. Design: Voluntary reporting of data on patients with acromegaly to an online database, by the managing physician. Methods: Data on demographics, diagnosis, estimated date of initial symptoms and diagnosis, pituitary imaging, visual fields, GH and IGF-I concentrations (requested locally), medical, radiotherapy and neurosurgical treatments, morbidity and mortality were collected. Results: Data were included for 1219 patients (60.8% women) with a mean age at diagnosis of 45 years (S.D. 14 years). Reporting was maximal in 1997 (2.1 cases per million inhabitants (c.p.m.) per year); prevalence was globally 36 c.p.m., but varied between 15.7 and 75.8 c.p.m. in different regions. Of 1196 pituitary tumours, most were macroadenomas (73%); 81% of these patients underwent surgery, 45% received radiotherapy and 65% were given medical treatment (somatostatin analogues in 68.3% and dopamine agonists in 31.4%). Cures (GH values (basal or after an oral glucose tolerance test) , 2 ng/ml, normal IGF-I, or both) were observed in 40.3% after surgery and 28.2% after radiotherapy. Hypertension (39.1%), diabetes mellitus (37.6%), hypopituitarism (25.7%), goitre (22.4%), carpal tunnel syndrome (18.7%) and sleep apnoea (13.2%) were reported as most frequent morbidities; 6.8% of the patients had cancer (breast in 3.1% of the women and colon in 1.2% of the cohort). Fifty-six patients died at a mean age of 60 years (S.D. 14 years), most commonly of a cardiovascular cause (39.4%); mortality was greater in patients given radiotherapy (hazard ratio 2.29; 95% confidence interval 1.03 to 5.08; P ¼ 0.026), and in those in whom GH and IGF-I concentrations were never normal (P , 0.001). Conclusions: This acromegaly registry offers a realistic overview of the epidemiological characteristics, treatment outcome and morbidity of acromegaly in Spain. As active disease and treatment with radiotherapy are associated with an increase in mortality, efforts to control the disease early are desirable.

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“…Many studies showed higher frequency of SAS in active acromegalic patients with a positive correlation with GH/IGF1 levels (3,12,13). Conversely, in the study of Grunstein et al (1) only the presence of central apnoea (CA), but not the degree of sleep apnoea, was associated with the disease activity.…”

Section: Introductionmentioning

confidence: 96%

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

Davì

Carbonare

Giustina

et al. 2008

European Journal of Endocrinology

129

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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.

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Prevalence of the sleep apnea syndrome in acromegaly population

Cited by 80 publications

References 17 publications

Effect of transsphenoidal surgery on sleep apnoea in acromegaly

Effect of transsphenoidal surgery on sleep apnoea in acromegaly

Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA)

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

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