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莫斯科地区肢端肥大症患者睡眠呼吸障碍的患病率及危险因素

Prevalence and risk factors of sleep breathing disorders in patients with acromegaly from Moscow region.

作者信息

Kovaleva Yu A, Dreval A V, Kulakov N V, Fedorova S I, Ilovayskaya I A

机构信息

Moscow Regional Research and Clinical Institute («MONIKI»), Moscow, Russia.

A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia.

出版信息

Ter Arkh. 2018 Nov 22;90(10):65-70. doi: 10.26442/terarkh2018901065-70.

Abstract

AIM

Assessment of prevalence and risk factors of sleep breathing disorders in patients with acromegaly from Moscow region.

MATERIALS AND METHODS

Cardiorespiratory monitoring was executed to 55 patients with acromegaly (18 men and 37 women): 27 patients with de novo disease, 28 patients on treatment of acromegaly (including 18 patietns with uncontrolled and 10 - with controlled acromegaly). All subgroups did not differ on sex, BMI and age. Also 24-hour monitoring of arterial blood pressure was carried out in 39 patients (12 men and 27 women, 14 patients with de novo acromegaly, 15 and 10 patients with uncontrolled and controlled acromegaly, respectively).

RESULTS

The high prevalence of sleep breathing disorders (SBD) was revealed in patients with acromegaly from Moscow Region. SBD was found in 92.6%, 83.5% and 70.0% patients with newly diagnosed, uncontrolled and controlled acromegaly, respectively. The majority of patients had severe/moderate SBD in all subgroups (78.8%, 72.2% and 60.0%, respectively). In patients with newly diagnosed and uncontrolled acromegaly index of apnea-hypopnea (31 and 38.5 respectively), number of apnoe episodes (76 and 72) and saturation level (93% and 93.5%) did not differ significantly while these parameters were better in patients with a controlled acromegaly (apnea-hypopnea index 20, apnea episodes 45.5 and saturation level 95%). The peak of desaturation was subphysiological in 91.7%, 86.7% and 77.8% of patients with newly diagnosed, uncontrolled and controlled acromegaly, respectively. Severity of SBD did not depend on GH and IGF-1 levels as well as acromegaly duration. Such all-population risk factors of SBD as BMI and age were valuable for patients with acromegaly, however gender did not matter. SBD were associated with lack of physiological decrease of systolic and diastolic night BP.

CONCLUSION

Acromegaly per se is a strong risk factor of sleep breathing disorders. The high prevalence of sleep breathing disorders in patients with acromegaly even after achievement of control over a disease emphasized need of specialized treatment of these violations.

摘要

目的

评估莫斯科地区肢端肥大症患者睡眠呼吸障碍的患病率及危险因素。

材料与方法

对55例肢端肥大症患者(18例男性和37例女性)进行心肺监测:27例初发疾病患者,28例接受肢端肥大症治疗的患者(包括18例病情未得到控制的患者和10例病情得到控制的患者)。所有亚组在性别、体重指数和年龄方面无差异。此外,对39例患者(12例男性和27例女性,14例初发肢端肥大症患者,15例病情未得到控制的肢端肥大症患者和10例病情得到控制的肢端肥大症患者)进行了24小时动脉血压监测。

结果

莫斯科地区肢端肥大症患者中睡眠呼吸障碍(SBD)的患病率较高。初发、病情未得到控制和病情得到控制的肢端肥大症患者中SBD的检出率分别为92.6%、83.5%和70.0%。所有亚组中的大多数患者患有重度/中度SBD(分别为78.8%、72.2%和60.0%)。初发和病情未得到控制的肢端肥大症患者的呼吸暂停低通气指数(分别为31和38.5)、呼吸暂停发作次数(76和72)和血氧饱和度水平(93%和93.5%)无显著差异,而病情得到控制的肢端肥大症患者的这些参数更好(呼吸暂停低通气指数20、呼吸暂停发作次数45.5和血氧饱和度水平95%)。初发、病情未得到控制和病情得到控制的肢端肥大症患者中分别有91.7%、86.7%和77.8%的患者血氧饱和度下降峰值低于生理水平。SBD的严重程度不取决于生长激素(GH)和胰岛素样生长因子-1(IGF-1)水平以及肢端肥大症病程。SBD的总体危险因素如体重指数和年龄对肢端肥大症患者有重要意义,而性别无关紧要。SBD与夜间收缩压和舒张压缺乏生理性下降有关。

结论

肢端肥大症本身是睡眠呼吸障碍的一个重要危险因素。即使在疾病得到控制后,肢端肥大症患者中睡眠呼吸障碍的高患病率强调了对这些异常情况进行专门治疗的必要性。

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