Saeki N, Isono S, Nishino T, Iuchi T, Yamaura A
Department of Neurological Surgery, Chiba-shi, Chiba, Japan.
Endocr J. 1999 Aug;46(4):585-90. doi: 10.1507/endocrj.46.585.
Sleep-disordered breathing (SDB) is common in patients with growth hormone (GH) secreting pituitary adenomas. Since long-term untreated SDB aggravates systemic conditions (hypertension and arrhythmia etc.), the therapeutic outcome of SDB is important in reducing morbidity and mortality rates. But the results of a quantitative analysis of the lowered GH and IGF-1 levels in SDB in a relatively large number of patients are not detailed. Ten consecutive acromegalic patients were studied with a bedside oximeter. Preoperatively they were divided into two groups based on the presence (SDB group = 6 patients) or absence (non-SDB group = 4 patients) of clinical symptoms of SDB such as habitual snoring, excessive daytime somnolence and nocturnal apneic episodes. The serum IGF-1 averaged 931.7 ng/ml in SDB group and 898.3 ng/ml in non-SDB group. The oxygen desaturation index (ODI) (the number of oxygen desaturations exceeding 4% from the base line) was 29.1+/-15.4 in the SDB group and 2.5+/-1.8 in the non-SDB group (P=0.01). Other oximeter parameters such as the percent of the time spent at O2 saturation < 90% and the mean and the lowest O2 saturations closely correlated with the degree of the clinical symptoms. A postoperative sleep study was conducted in 5 patients in the preoperative SDB group, 4 months or more after the surgery. The serum GH and IGF-1 levels normalized in 3 patients but remained slightly high in 2. ODI became 9.1+/-5.6, which was significantly lower than the preoperative value (P=0.026). One patient had a complete clinical resolution. The other 4 obtained slight to moderate improvement clinically and oximetrically despite normalized or decreased hormonal levels. This study clarified that the response of SDB to lowering of the GH level varies from one patient to another and persisting SDB despite the normalization of the hormonal levels suggests the involvement of other factors in the production of SDB.
睡眠呼吸障碍（SDB）在分泌生长激素（GH）的垂体腺瘤患者中很常见。由于长期未经治疗的SDB会加重全身状况（如高血压和心律失常等），SDB的治疗结果对于降低发病率和死亡率很重要。但是，在相对大量的患者中对SDB中降低的GH和IGF-1水平进行定量分析的结果并不详细。对连续10例肢端肥大症患者使用床边血氧仪进行研究。术前，根据是否存在SDB的临床症状（如习惯性打鼾、白天过度嗜睡和夜间呼吸暂停发作）将他们分为两组（SDB组=6例患者，非SDB组=4例患者）。SDB组血清IGF-1平均为931.7 ng/ml，非SDB组为898.3 ng/ml。氧饱和度下降指数（ODI）（从基线起氧饱和度下降超过4%的次数）在SDB组为29.1±15.4，在非SDB组为2.5±1.8（P=0.01）。其他血氧仪参数，如血氧饱和度<90%的时间百分比、平均血氧饱和度和最低血氧饱和度与临床症状的程度密切相关。对术前SDB组的5例患者在术后4个月或更长时间进行了术后睡眠研究。3例患者的血清GH和IGF-1水平恢复正常，但2例仍略高。ODI变为9.1±5.6，显著低于术前值（P=0.026）。1例患者临床症状完全缓解。其他4例患者尽管激素水平恢复正常或下降，但在临床和血氧测定方面有轻微至中度改善。这项研究表明，SDB对GH水平降低的反应因人而异，并且尽管激素水平恢复正常但SDB持续存在表明其他因素参与了SDB的产生。
