Celik Deniz, Duyar Sezgi Sahin, Aksu Funda, Firat Selma, Ciftci Bulent
Dr. Deniz Celik, Health Sciences University Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Ankara Turkey.
Dr. Sezgi Sahin Duyar, Health Sciences University Ataturk Chest Diseases and Thoracic Surgery Education and Research Hospital, Sleep Disorders Center, Ankara Turkey.
Pak J Med Sci. 2021 Jul-Aug;37(4):1161-1165. doi: 10.12669/pjms.37.4.4229.
It is known that the prevalence of obstructive sleep apnea (OSA) is increased in acromegaly. Craniofacial anomalies, macroglossia, and thickening of the laryngeal wall caused by the increase in soft tissue in these patients lead to OSA. Also, the increase in growth hormone can trigger central apnea by causing a decrease in respiratory drive. Determining the polysomnographic characteristics of acromegaly patients is important to reveal the effect of these mechanisms.
The demographic and polysomnographic characteristics of 33 acromegaly patients who underwent polysomnography (PSG) with suspicion of sleep disorders between 2011 and 2018 in the sleep laboratory of our hospital were retrospectively analyzed. One of the patients was excluded from the analysis because PSG was performed in the postoperative period. The remaining 32 patients with active acromegaly were grouped according to their gender and the presence of OSA and compared with statistical methods in terms of polysomnographic and clinical features.
OSA (AHI>5) was detected in 78.1% of 32 active acromegaly patients (18 females, 14 males) who underwent PSG with suspicion of sleep-disordered breathing. Moderate-severe OSA (62.5%) was found in most patients, and there was no difference between the sexes in terms of OSA detection rate and OSA severity. Respiratory events appear to be predominantly obstructive hypopneas. Also, the polysomnographic features of female and male acromegaly patients with OSA were found to be similar. It is seen that the OSA group is similar to the group with simple snoring in terms of body mass index (BMI), but is statistically significantly older (p=0,007). A positive correlation was found between age and AHI in pairwise correlation analysis (r:0,426 p:0,015, respectively).
Considering that the prevalence of OSA in the population is approximately 5%, our results show that the risk of OSA in acromegaly increases, and obstructive pathways are effective in this increase. The probability of OSA occurrence and polysomnographic features between the genders are similar. Although the median BMI of the patients with and without OSA was similar, the median age was higher in the group with OSA, middle-aged acromegaly patients should be evaluated in terms of OSA even if there is no obvious obesity.
已知肢端肥大症患者阻塞性睡眠呼吸暂停（OSA）的患病率增加。这些患者的颅面畸形、巨舌症以及软组织增加导致的喉壁增厚会引发OSA。此外，生长激素增加可通过导致呼吸驱动力下降引发中枢性呼吸暂停。确定肢端肥大症患者的多导睡眠图特征对于揭示这些机制的作用很重要。
回顾性分析了2011年至2018年在我院睡眠实验室因怀疑睡眠障碍而接受多导睡眠图（PSG）检查的33例肢端肥大症患者的人口统计学和多导睡眠图特征。其中1例患者因PSG是在术后进行而被排除在分析之外。其余32例活动性肢端肥大症患者根据性别和是否存在OSA进行分组，并就多导睡眠图和临床特征采用统计学方法进行比较。
在32例因怀疑睡眠呼吸障碍而接受PSG检查的活动性肢端肥大症患者（18例女性，14例男性）中，78.1%检测出OSA（呼吸暂停低通气指数>5）。大多数患者存在中度至重度OSA（62.5%），OSA检出率和OSA严重程度在性别上无差异。呼吸事件似乎主要是阻塞性呼吸浅慢。此外，发现有OSA的肢端肥大症女性和男性患者的多导睡眠图特征相似。可见OSA组与单纯打鼾组在体重指数（BMI）方面相似，但在统计学上年龄显著更大（p = 0.007）。在成对相关性分析中，年龄与呼吸暂停低通气指数之间存在正相关（r分别为0.426，p为0.015）。
考虑到人群中OSA的患病率约为5%，我们的结果表明肢端肥大症患者发生OSA的风险增加，且阻塞性途径在这种增加中起作用。OSA发生的概率和多导睡眠图特征在性别之间相似。尽管有和没有OSA的患者的BMI中位数相似，但OSA组的年龄中位数更高，中年肢端肥大症患者即使没有明显肥胖也应进行OSA评估。
