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

Abstract

BackgroundWhether sleep apnoea syndrome (SAS) subsides after biochemical and clinical remission of acromegaly is controversial.ObjectiveTo 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.DesignCross-sectional and longitudinal study.SettingItalian university department of internal medicine.PatientsAbout 36 acromegalic patients: 18 active and 18 controlled.MeasurementsPolysomnography was performed in all patients and repeated in six with active acromegaly and SAS after achieving disease control. Echocardiographic parameters were also measured.ResultsThe 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.ConclusionSAS 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.