Potential benefits of sleep medicine in acromegalics: preliminary results from a case-control study
G. Pioa (Dr), T. Feola*b (Dr), L. Rostomyanc (Dr), G. Vitranib (Dr), P. Petrossiansc (Prof), A. Beckersc (Prof), A. Romigib (Dr), ML. Jaffrain-Reab (Prof)
a University of L 'Aquila, Department of Biotechnological and Applied Clinical Sciences, L'Aquila, ITALY ; b Neuromed Institute, IRCCS, Pozzilli (is), ITALY ; c Centre Hospitalier Universitaire de Liège, Department of Endocrinology, Liege, BELGIUM
Introduction: The Obstructive Sleep Apnea (OSA) syndrome is highly prevalent in acromegaly (> 80%) and often persists after disease remission. We report a series of acromegalics in whom ventilation therapy was indicated on the basis of standard criteria and compare OSA severity, co-morbidities and the impact of ventilation therapy (CPAP) with a control group. Methods: Thirty acromegalics (ACRO) - 22/30 with active disease - were compared to 30 OSA patients matched for age, gender, and BMI (CTRL). Each group included 21 M, 9 F, median age 53.5 yrs in ACRO vs 54.5 yrs in CTRL, (P ns). Hypertension (HT) and diabetes mellitus (DM) were recorded. After basal home-sleep apnea test or polysomnography, CPAP was indicated according to current guidelines and a second sleep study was available in 21 ACRO, 6/21 with an active disease. Continuous data are expressed as median (range) and analysed by non-parametric tests, percentages were compared by the Chi-square test. P<0.05 was considered significant. Results: At baseline, most ACRO and CTRL had severe OSA (23/30 each, 76.6%) and AHI was not significantly higher in ACRO than in CTRL (median 44.7 vs 35.1 AHI/h, P ns). HT and DM were significantly more prevalent in ACRO than in CTRL (87.7% vs 57.1% for HT, P=0.012; 43.3% vs 3.6% for DM, P< 0.001). Data at second sleep evaluation were compared between 21 ACRO (14 on CPAP therapy) and their matched CTRL patients. A remarkable improvement was observed in both groups (median AHI 7.30 vs 4.75/h, -86.4% vs -88.9% P ns), in particular in the ACRO-CPAP subgroup (AHI 3.1/h; -93.9%, P=0.068 vs CTRL). In acromegalics, AHI decrease (% of baseline) was also significantly correlated with the decrease in BMI (P =0.041) and tended to be correlated with the decrease in IGF1 (P = 0.07). Discussion: Compared to OSA patients with similar demographics and BMI, no clear increase in OSA severity was observed in ACRO. However, comorbidities were more severe, which is a further indication to actively treat OSA. These preliminary data suggest that CPAP should be considered early in the management of acromegaly, including the active phase of the disease.
The author has declared no conflict of interest.