Sleep apnea syndrome in acromegalic patients: Can morphological evaluation guide us to optimize treatment?

Excerpt

Sleep apnea syndrome (SAS) is a common complication in patients with newly diagnosed acromegaly. Different series have noted a relatively high prevalence (45–80 %), which is significantly higher than that of the general population (2–4 %) [1, 2], although it is probably still under-assessed [3]. In this setting, a recent consensus on acromegaly complications stated that every patient should undergo a careful symptomatic [for example, with an Epworth Sleepiness scale score (ESS)] and/or laboratory assessment for SAS at the time of diagnosis, in collaboration with a respiratory physician [3]. Obstructive SAS (OSAS) is the prevailing form in acromegaly; this occurs due to craniofacial deformations, hypertrophy of pharyngeal soft tissue, macroglossia and thickening of upper airway, all of which hamper the airflow through upper airways. Several predisposing factors can be correlated with the onset of OSAS in acromegaly, such as age, male gender, neck and finger circumference, body mass index, sedatives, alcohol, diabetes mellitus, hypertension, myocardial ischemia, arrhythmias, heart failure, and previous stroke [2]. At the same time, central SAS may develop due to inhibition of the breathing center caused by elevated serum GH/IGF-I levels or to the enhanced somatostatin tone [4]. Therefore, disease-specific parameters, such as high levels of GH/IGF-I and active disease duration, can be also correlated with the severity of SAS [2]. …