Professor K. S. L. Lam, Division of Endocrinology and Metabolism, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China. Fax: +852 2816 2863; E-mail: [email protected]

Read the full text

About

PDF

Tools

Share a link

Email
Wechat
Bluesky

Abstract

OBJECTIVES Sleep apnoea has been reported to occur in subjects with acromegaly. This study evaluates the relationship among biochemical activity, sleep apnoeic activity and upper airway anatomic profile in acromegaly, and the effect of Sandostatin^® LAR^®, a long-acting somatostatin analogue, on these parameters.

PATIENTS Fourteen subjects with acromegaly were recruited.

MEASUREMENTS Subjects were assessed at baseline and those with apnoea-hypopnoea index (AHI) ≥ 5 were reassessed after 6 months of treatment with Sandostatin^® LAR^® 20–30 mg IMI 4-weekly. Biochemical activity was assessed with levels of GH and IGF-1. Sleep disordered breathing was assessed with overnight polysomnography. Upper airway anatomic profile was defined with computerized tomographic cephalometry.

RESULTS Of 14 subjects (age 42·0 ± 8·1 years, mean ± SD; 11 men) at baseline, there was a positive correlation between GH and tongue length (VT; P = 0·004), and between AHI and cephalometric indices: length of soft palate (PMU; P = 0·002); mandibular plane-hyoid bone distance (MPH; P = 0·017), maximum thickness of soft palate (Max-SP; P = 0·018) and VT (P = 0·027). Eight patients had sleep disordered breathing (AHI ≥ 5) which was predominantly obstructive in nature (AHI = 29·4 ± 22·6). After treatment, there were significant improvements in hormonal profile: GH, mU/l (before, 51·5 ± 27·8; after, 8·0 ± 7·4; P = 0·017) and IGF-1, nmol/l (before, 95·5 ± 23·4; after, 35·0 ± 12·4; P = 0·012); sleep-disordered breathing: AHI (before, 29·4 ± 22·6; after, 13·4 ± 11·12; P = 0·025), snoring episodes (before, 486 ± 240; after, 165 ± 170; P = 0·05); cephalometric indices, mm: MPH (before, 18·8 ± 12·1; after, 14·8 ± 8·4; P = 0·018), VT (before, 72·3 ± 4·4; after, 69·7 ± 4·3; P = 0·05). There was a positive correlation between the reduction in GH and AHI (r = 0·738, P = 0·037).

CONCLUSIONS The findings demonstrated that there was correlation between sleep apnoea severity and soft tissue overgrowth at the upper airway region in acromegaly. They also suggest that Sandostatin^® LAR^® improved obstructive sleep apnoea in acromegaly, and the effect might be partly mediated via a reduction in upper airway soft tissue, in particular that of the tongue, concomitant with a reduction in GH levels.

References

Bradley, T.D., Brown, I.G., Grossman, R.F., Zamel, N., Martinez, D., Philipson, E.A., Hoffstein, V. (1986) Pharyngeal size in snorers, nonsnorers and patients with sleep apnoea. New England Journal of Medicine, 315 1327–1331.
10.1056/NEJM198611203152105
CAS PubMed Web of Science® Google Scholar
Cadieux, R.J., Kales, A., Santen, R.J., Bixler, E.O., Gordon, R. (1982) Endoscopic findings in sleep apnoea associated with acromegaly. Journal of Clinical Endocrinology and Metabolism, 55 18–22.
10.1210/jcem-55-1-18
CAS PubMed Web of Science® Google Scholar
Grunstein, R.R., Ho, K.Y., Sullivan, C.E. (1991) Sleep apnea in acromegaly. Annals of Internal Medicine, 115 572–532.
10.7326/0003-4819-115-7-527
PubMed Web of Science® Google Scholar
Grunstein, R.R., Ho, K.Y., Berthon-Jones, M., Stewart, D., Sullivan, C.E. (1994a) Central sleep apnea is associated with increased ventilatory response to carbon dioxide and hypersecretion of growth hormone in patients with acromegaly. American Journal of Respiratory and Critical Care Medicine, 150 496–502.
10.1164/ajrccm.150.2.8049836
CAS PubMed Web of Science® Google Scholar
Grunstein, R.R., Ho, K.Y., Sullivan, C.E. (1994b) Effect of octreotide, a somatostatin analog, on sleep apnea in patients with acromegaly. Annals of Internal Medicine, 121 478–483.
10.7326/0003-4819-121-7-199410010-00002
PubMed Web of Science® Google Scholar
Guilleminault, C., Riley, R., Powell, N. (1984) Obstructive sleep apnea and abnormal cephalometric measurements − implications for treatment. Chest, 86 793–794.
10.1378/chest.86.5.793
CAS PubMed Web of Science® Google Scholar
Guylay, S., Olson, L.G., Hensley, M.J., King, M.T., Allen, K.M., Saunders, N.A. (1993) A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea. American Review of Respiratory Disease, 147 50–53.
10.1164/ajrccm/147.1.50
PubMed Web of Science® Google Scholar
Hart, T.B., Radow, S.K., Blackard, W.G., St. George Tucker, H., Cooper, K.R. (1985) Sleep apnea in active acromegaly. Archives of Internal Medicine, 145 865–866.
CAS PubMed Web of Science® Google Scholar
Isono, S., Saeki, N., Tanaka, A., Nishino, T. (1999) Collapsibility of passive pharynx in patients with acromegaly. American Journal of Respiratory and Critical Care Medicine, 160 64–68.
10.1164/ajrccm.160.1.9806054
CAS PubMed Web of Science® Google Scholar
International Diabetes Institute: World Health Organization (2000). The Asia-Pacific Perspective: Redefining Obesity and its Treatment, pp. 15–21. Health Communications Pty Ltd, Australia.
Google Scholar
Leibowitz, G., Shapiro, M.S., Salameh, M., Glaser, B. (1994) Improvement of sleep apnoea due to acromegaly during short-term treatment with octreotide. Journal of Internal Medicine, 236 231–235.
10.1111/j.1365-2796.1994.tb01288.x
PubMed Web of Science® Google Scholar
Lyberg, T., Krogstad, O., Djupesland, G. (1989a) Cephalometric analysis in patients with obstructive sleep apnoea syndrome. I. Skeletal morphology. Journal of Laryngology and Otolaryngology, 103 287–292.
10.1017/S0022215100108734
PubMed Web of Science® Google Scholar
Lyberg, T., Krogstad, O., Djupesland, G. (1989b) Cephalometric analysis in patients with obstructive sleep apnoea syndrome. I. Soft tissue morphology. Journal of Laryngology and Otolaryngology, 103 293–297.
10.1017/S0022215100108746
CAS PubMed Web of Science® Google Scholar
Maltais, F., Carrier, G., Cormier, Y., Series, F. (1991) Cephalometric measurements in snorers, non-snorers, and patients with sleep apnoea. Thorax, 45 119–123.
Google Scholar
Melmed, S. (1990) Acromegaly. New England Journal of Medicine, 322 966–977.
10.1056/NEJM199004053221405
PubMed Web of Science® Google Scholar
Pekkarinen, T., Partinen, M., Pelkonen, R., Iivanainen, M. (1987) Sleep apnoea and daytime sleepiness in acromegaly: relationship to endocrinological factors. Clinical Endocrinology, 27 649–654.
10.1111/j.1365-2265.1987.tb02947.x
CAS PubMed Web of Science® Google Scholar
Perks, W.H., Horrocks, P.M., Cooper, R.A., Bradbury, S., Allen, A., Baldock, N., Prowse, K., Van'T Hoff, W (1980) Sleep apnoea in acromegaly. British Medical Journal, 280 894–897.
10.1136/bmj.280.6218.894
CAS PubMed Web of Science® Google Scholar
Pelttari, L., Rauhala, E., Vuoriluoto, J., Aitaslo, K., Hyyppa, M.T., Kronholm, E., Irjala, K., Vilkari, J. (1995) Nocturnal breathing abnormalities in acromegaly after adenomectomy. Clinical Endocrinology, 43 175–182.
10.1111/j.1365-2265.1995.tb01912.x
CAS PubMed Web of Science® Google Scholar
Rechtschaffen, A. & Kales, A.A. (1968) eds. A Manual of Standardized Terminology, Techniques and Scoring for Sleep Stages of Human Subjects, NIH publication no. 204. Government Printing Office, Washington, DC.
Google Scholar
Rosenow, F., Reuter, S., Deu, U., Szellies, B., Hilgerst, R.D., Winkelmann, W., Heiss, W.D. (1996) Sleep apnoea in treated acromegaly: relative frequency and predisposing factors. Clinical Endocrinology, 45 563–569.
10.1046/j.1365-2265.1996.00852.x
PubMed Web of Science® Google Scholar
Wickwire, N.A., White, R.P., Proffit, W.R. (1972) The effect of mandibular osteotomy on tongue position. Journal of Oral Surgery, 30 184–190.
CAS PubMed Web of Science® Google Scholar
Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., Badr, S. (1993) The occurrence of sleep-disordered breathing among middle-aged adults. New England Journal of Medicine, 328 1230–1273.
10.1056/NEJM199304293281704
CAS PubMed Web of Science® Google Scholar
Zucconi, M., Ferini-Strambi, L., Palazzi, S., Orena, C., Zonta, S., Smirne, S. (1992) Habitual snoring with and without obstructive sleep apnoea: the importance of cephalometric variables. Thorax, 47 157–161.
10.1136/thx.47.3.157
CAS PubMed Web of Science® Google Scholar

Citing Literature

Volume55, Issue4

October 2001

Pages 477-483

Effect of Sandostatin^® LAR^® on sleep apnoea in acromegaly: correlation with computerized tomographic cephalometry and hormonal activity

Abstract

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Effect of Sandostatin® LAR® on sleep apnoea in acromegaly: correlation with computerized tomographic cephalometry and hormonal activity

Abstract

References

Citing Literature

References

Related

Information

Effect of Sandostatin^® LAR^® on sleep apnoea in acromegaly: correlation with computerized tomographic cephalometry and hormonal activity