Abstract
PurposePatients with acromegaly have an increased risk of sleep apnea, but reported prevalence rates vary largely. Here we aimed to evaluate the sleep apnea prevalence in a large national cohort of patients with acromegaly, to examine possible risk factors, and to assess the proportion of patients diagnosed with sleep apnea prior to acromegaly diagnosis.MethodsCross-sectional multicenter study of 259 Swedish patients with acromegaly. At patients’ follow-up visits at the endocrine outpatient clinics of all seven university hospitals in Sweden, questionnaires were completed to assess previous sleep apnea diagnosis and treatment, cardiovascular diseases, smoking habits, anthropometric data, and S-IGF-1 levels. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale. Patients suspected to have undiagnosed sleep apnea were referred for sleep apnea investigations.ResultsOf the 259 participants, 75 (29%) were diagnosed with sleep apnea before the study start. In 43 (57%) of these patients, sleep apnea had been diagnosed before the diagnosis of acromegaly. After clinical assessment and sleep studies, sleep apnea was diagnosed in an additional 20 patients, yielding a total sleep apnea prevalence of 37%. Higher sleep apnea risk was associated with higher BMI, waist circumference, and index finger circumference. Sleep apnea was more frequent among patients with S-IGF-1 levels in the highest quartile.ConclusionSleep apnea is common among patients with acromegaly, and is often diagnosed prior to their acromegaly diagnosis. These results support early screening for sleep apnea in patients with acromegaly and awareness for acromegaly in patients with sleep apnea.
Highlights
Is a rare disease with an annual incidence of 3–7 cases per 1 million persons, and a prevalence of 60–134 per million [1,2,3,4,5]
Patients with acromegaly often suffer from sleep apnea [9, 10, 13,14,15,16,17,18,19,20,21,22], which is characterized by recurrent episodes of apnea during sleep followed by hypoxemia, sympathetic activation, frequent arousals from sleep, and excessive daytime sleepiness [23, 24]
We further identified high BMI, waist circumference, and index finger circumference as significant risk factors for sleep apnea, and found that patients with SIGF-1 in the highest quartile were more likely to have sleep apnea
Summary
Is a rare disease with an annual incidence of 3–7 cases per 1 million persons, and a prevalence of 60–134 per million [1,2,3,4,5] It is almost always caused by a growth hormone-secreting pituitary adenoma [4, 6]. Is often diagnosed several years after the initial onset of symptoms, by which point most patients have marked and irreversible disease manifestations [11, 12] Such diagnostic delays increase mortality and allow further pituitary adenoma growth that reduces the possibilities for complete surgical excision [4, 6, 11]. According to a recent Italian study of the awareness and management of sleep apnea in acromegaly, 43% of centers referred less than 20% of their patients for polysomnography, raising concerns about possible under-diagnosis of the disorder [31]
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