肢端肥大症患者睡眠呼吸暂停和肺功能异常的患病率
Prevalence of sleep apnea and lung function abnormalities in patients with acromegaly.
作者信息
Hashim Zia, Gupta Mansi, Nath Alok, Khan Ajmal, Neyaz Zafar, Tiwari Satyendra, Mishra Ravi, Srivastava Shivani, Gupta Sushil
机构信息
Department of Pulmonary Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Radiodiagnosis, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
出版信息
Lung India. 2022 Jan-Feb;39(1):58-64. doi: 10.4103/lungindia.lungindia_182_21.
BACKGROUND
Sleep apnea (SA) is highly prevalent in acromegaly. Ethnicity influences the prevalence of SA in the general population. We studied the prevalence of SA and other respiratory comorbidities in North Indian patients with active acromegaly.
DESIGN
Prospective, observational.
MATERIALS AND METHODS
Consecutive adult patients with active acromegaly (n = 35, age 39.7 ± 13.2 years) and hypersomatotropism (nonsuppression of serum growth hormone after oral glucose and elevated serum insulin-like growth factor-1 [IGF-1]) were evaluated for respiratory symptoms, scoring for SA (Epworth Sleepiness Score [ESS] and STOP-BANG), pulmonary function tests (PFT), high-resolution computerized tomography (HRCT) of the thorax, polysomnography (PSG), and transthoracic echocardiography. Age- and sex-matched healthy individuals (n = 34) served as controls.
RESULTS
Acromegaly subjects had dyspnea (34%), cough (37%), excessive daytime somnolence (43%), and fatigue (49%). Clinically significant ESS (>10) and STOP-BANG score (≥3) were present in 41% and 68.6% of subjects, respectively. PFT showed restrictive and obstructive patterns in 45.7% and 11.4% of acromegalics respectively; with higher total lung capacity (TLC), thoracic gas volume (TGV), and residual volume (RV). PSG revealed significantly higher SA events in acromegalics (central [acromegaly 24.63 ± 37.82 vs. control 3.21 ± 5.5], mixed [11 ± 19.46 vs. 3.50 ± 5.96], obstructive [34.86 ± 44.37 vs. 9.71 ± 10.48], and mean apnea-hypopnea index [AHI] [16.91 ± 18.0 vs. 7.86 ± 7.84]). Acromegalics had significantly higher prevalence of obstructive SA (71.4% [mild 31.4%, moderate 20%, severe 20%]) as compared to controls (38.2%). There was no correlation of AHI with serum IGF-1 and disease duration.
CONCLUSION
Acromegaly subjects have a significantly higher prevalence of respiratory symptoms, SA, and abnormalities in PFT. Screening for respiratory comorbidities should be routinely recommended in all patients with acromegaly.
背景
睡眠呼吸暂停（SA）在肢端肥大症中非常普遍。种族影响普通人群中SA的患病率。我们研究了北印度活动性肢端肥大症患者中SA及其他呼吸合并症的患病率。
设计
前瞻性观察研究。
材料与方法
对连续性成年活动性肢端肥大症患者（n = 35，年龄39.7±13.2岁）和生长激素过多症患者（口服葡萄糖后血清生长激素未被抑制且血清胰岛素样生长因子-1[IGF-1]升高）进行呼吸症状评估、SA评分（爱泼沃斯嗜睡量表[ESS]和STOP-BANG问卷）、肺功能测试（PFT）、胸部高分辨率计算机断层扫描（HRCT）、多导睡眠图（PSG）和经胸超声心动图检查。年龄和性别匹配的健康个体（n = 34）作为对照。
结果
肢端肥大症患者有呼吸困难（34%）、咳嗽（37%）、白天过度嗜睡（43%）和疲劳（49%）。分别有41%和68.6%的患者临床显著ESS（>10）和STOP-BANG评分（≥3）。PFT显示45.7%的肢端肥大症患者有限制性模式，11.4%有阻塞性模式；总肺容量（TLC）、胸腔气体容量（TGV）和残气量（RV）较高。PSG显示肢端肥大症患者的SA事件显著更多（中枢性[肢端肥大症24.63±37.82 vs.对照3.21±5.5]、混合型[11±19.46 vs. 3.50±5.96]、阻塞性[34.86±44.37 vs. 9.71±10.48]以及平均呼吸暂停低通气指数[AHI][16.91±18.0 vs. 7.86±7.84]）。与对照组（38.2%）相比，肢端肥大症患者阻塞性SA的患病率显著更高（71.4%[轻度31.4%，中度20%，重度20%]）。AHI与血清IGF-1和疾病持续时间无相关性。
结论
肢端肥大症患者呼吸症状、SA和PFT异常的患病率显著更高。应常规建议对所有肢端肥大症患者进行呼吸合并症筛查。
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