How Do Disease Activity, Treatment Affect Risk for Sleep Apnea in Acromegaly?

Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping.
The prevalence of obstructive sleep apnea in patients with acromegaly is similar in the presence of active or inactive disease.

The prevalence of obstructive sleep apnea (OSA) in patients with acromegaly is similar in the presence of active or inactive disease, but Apnea-Hypopnea Index (AHI) improves after short-term treatment for acromegaly, according to results of a meta-analysis published in The Journal of Clinical Endocrinology & Metabolism.

One of the most common comorbidities of acromegaly is sleep apnea, mainly OSA, with 20% to 80% of patients with acromegaly affected by the breathing disorder. The diagnosis of OSA is based on AHI >5 events/h. Guidelines for management of acromegaly recommend screening for OSA and treatment for acromegaly can improve sleep apnea. However, the sleep breathing disorder may persist even in cases of controlled acromegaly.

In the meta-analysis, the goal was to explore the effects of acromegaly disease activity on the prevalence of OSA and the effect of medical and surgical treatment for acromegaly on AHI.

The comprehensive literature search identified 21 manuscripts, including 24 primary studies with a total of 734 patients. The included studies were both cross-sectional and longitudinal studies that compared active and well-controlled disease or compared acromegaly before and after medical or surgical treatment. Studies were also required to have recorded OSA prevalence and characteristics.

The outcomes of interest included OSA prevalence and AHI in active and well-controlled patients with acromegaly in cross-sectional studies, as well as AHI before and after treatment for acromegaly in longitudinal studies.

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Of the included studies, 10 reported OSA prevalence in active (179 cases) and well-controlled acromegaly (218 cases), with statistical analysis showing no difference in prevalence between the groups (effect size, -0.16; 95% CI, -0.47 to 0.15; P =.32). A total of 6 studies compared AHI in active (87 cases) and well-controlled disease (109 cases), and analysis showed similar AHI in both groups (effect size, -0.03; 95% CI, -0.49 to 0.43; P =.89).

As for studies comparing AHI in patients with acromegaly before and after treatment (141 cases), analysis revealed AHI was significantly lower after medical or surgical intervention (effect size, -0.36; 95% CI, -0.49 to -0.23; P <.0001).

A meta-regression analysis showed that severe OSA was a significant determinant of the difference in prevalence of OSA and AHI in patients with active acromegaly compared with patients with well-controlled disease. On the other hand, levels of growth hormone and insulinlike growth factor had no effect on OSA prevalence in this population.

The researchers acknowledged several limitations of the meta-analysis, including missing data on the clinical symptoms of OSA after treatment, as well as limited information on smoking status; hypogonadism; hypothyroidism; and neck, waist, and hip circumferences.

“OSA monitoring should be ongoing in the long-term follow-up of [patients with acromegaly], and should be monitored even in well-controlled patients, because this comorbidity could contribute to an increased cardiovascular risk,” concluded the researchers.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Parolin M, Dassie F, Alessio L, et al. Obstructive sleep apnea in acromegaly and the effect of treatment: a systematic review and meta-analysis [published online November 13, 2019]. J Clin Endocrinol Metab. doi:10.1210/clinem/dgz116