Abstract


Introduction: Sleep apnea syndrome (SAS) is a frequently reported complication in acromegaly patients that influences their quality of life and long term morbidity and possibly mortality. Prospective studies on the course of SAS in these patients are scarce. This study investigates changes in SAS during the first 2,5 years after initiation of acromegaly treatment. view more

Introduction: Sleep apnea syndrome (SAS) is a frequently reported complication in acromegaly patients that influences their quality of life and long term morbidity and possibly mortality. Prospective studies on the course of SAS in these patients are scarce. This study investigates changes in SAS during the first 2,5 years after initiation of acromegaly treatment.
Methods: Twenty-six patients (mean ± SEM; age 51.8 ± 2.6 years, 11 males) with untreated acromegaly were included in this prospective study. Polysomnography (PSG) was performed at baseline (T0, i.e.at diagnosis, before initiation of treatment). Fifteen patients (mean ± SEM; age 54.9 ± 3.5 years, 7 males) have completed at present the prospective follow-up: they repeated this investigation one year (T1) and two-and-a-half years (T2) after they had been treated with somatostatin receptor analogs (SSA) for 6 months, followed by endonasal endoscopic transsphenoidal adenomectomy. Nine patients were cured of acromegaly after surgery (as documented by normal IGF-1 levels and adequate suppression of GH levels during an oral glucose tolerance test) and 6 patients required subsequent medical treatment leading to biochemically controlled disease. Changes in outcome variables during follow-up were correlated to changes in insulin-like growth factor-1 (IGF-1) levels.
Results: At baseline, 23/26 (88.5%) patients were diagnosed with SAS of which 21 (91.3%) had obstructive SAS. Polysomnographic indices improved significantly during follow-up (T0 vs. T2, n=15): respiratory-disturbance-index (RDI) 27.4 (3.1-99.2) vs. 6.6 (0.4-24.1), p=0.002, apnea-hypopnea-index (AHI) 19.9 (2.9-64.6) vs. 4.0 (0.4-20.8), p=0.003, oxygen-desaturation-index (ODI) 22.7 (2.8-80.5) vs. 6.4 (0.3-21), p=<0.001 and lowest oxygen saturation 81.1 ± 2% vs. 87 ± 0.8%, p=0.001. In addition, the Epworth Sleepiness scores improved significantly (12.1 (1.24) vs. (6.7 (0.74); p <0.001). Of the 15 patients who completed the follow-up, SAS improved significantly in all and 13 of these patients were fully cured of SAS 2,5 years after diagnosis. Changes in IGF-1 levels correlated with changes in RDI (r=0.998), ODI (r=1.0), lowest oxygen saturation (r=1.0), ESS (r=0.994) and AHI (r=1.0).
Conclusions: SAS recovered in nearly all cured or biochemically controlled acromegaly patients; PSG at diagnosis of acromegaly is recommended as the incidence of SAS is very high in this population. Repeated PSG is recommended after successful treatment of acromegaly as this might also have cured or improved the SAS.

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