Almazov National Medical Research Center, Laboratory of Somnology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341.
Almazov National Medical Research Center, Laboratory of Endocrinology, Ulitsa Akkuratova, 2, St Petersburg, Russia, 197341.
Sleep Breath. 2023 Dec;27(6):2305-2314. doi: 10.1007/s11325-023-02838-9. Epub 2023 May 6.
We hypothesized that an unfavorable cardiovascular profile in acromegaly is associated with sleep-disordered breathing (SDB), while acromegaly control improves both respiratory sleep characteristics and the cardiovascular profile.
The patients underwent the assessment of breathing during sleep and cardiovascular profile assessment at the start of the study including arterial stiffness, blood pressure, echocardiography, nocturnal heart rate variability (HRV). The assessment was repeated in patients with acromegaly at 1 year after transsphenoidal adenectomy (TSA).
A total of 47 patients with acromegaly and 55 control subjects were enrolled. At one year after TSA, 22 patients with acromegaly were reassessed. Multiple linear regression analysis with adjustment for age, sex and body mass index (BMI) showed the associations of insulin growth-like factor 1 (IGF-1) with obstructive apnea index (OAI: β=0.035/h, p<0.001), but not with cardiovascular parameters, in patients with acromegaly. The analysis of combined acromegaly and control dataset with adjustment for age, sex and BMI showed the association the presence of acromegaly with diastolic blood pressure (DBP; β=17.99 mmHg, p<0.001), ejection fraction (EF; β=6.23%, p=0.009), left heart remodeling (left ventricle posterior wall: β=0.81 mm, p=0.045) and the association of the presence of SDB (apnea-hypopnea index≥15/h) with left ventricular function (EF: -4.12%, p=0.040; end systolic volume: 10.12 ml, p=0.004). Control of acromegaly was accompanied by the decrease in OAI (5.9 [0.8, 14.5]/h and 1.7 [0.2, 5.1]/h, p=0.004) and nocturnal heart rate (66.1 [59.2, 69.8] bpm and 61.7 [54.0, 67.2] bpm, p=0.025) and by the increase in blood pressure (DBP: 78.0 [70.3, 86.0] mm Hg and 80.0 [80.0, 90.0] mm Hg, p=0.012).
The comorbidities of acromegaly, including sleep-disordered breathing, appear to have a long-term effect on cardiovascular remodeling in active acromegaly. Future studies should investigate the applicability of the treatment of SDB for the reduction of cardiovascular risk in acromegaly.
我们假设肢端肥大症患者心血管不良状况与睡眠呼吸障碍（SDB）有关，而肢端肥大症控制可改善呼吸睡眠特征和心血管状况。
在研究开始时，患者接受了睡眠期间呼吸和心血管状况评估，包括动脉僵硬度、血压、超声心动图、夜间心率变异性（HRV）。在经蝶窦腺瘤切除术（TSA）后 1 年，对肢端肥大症患者进行重复评估。
共纳入 47 例肢端肥大症患者和 55 例对照组患者。TSA 后 1 年，对 22 例肢端肥大症患者进行了重新评估。多变量线性回归分析调整年龄、性别和体重指数（BMI）后，结果显示胰岛素样生长因子 1（IGF-1）与阻塞性呼吸暂停指数（OAI）呈正相关（β=0.035/h，p<0.001），但与心血管参数无关。调整年龄、性别和 BMI 后，对肢端肥大症和对照组联合数据集进行分析，结果显示肢端肥大症与舒张压（DBP；β=17.99mmHg，p<0.001）、射血分数（EF；β=6.23%，p=0.009）、左心重构（左心室后壁：β=0.81mm，p=0.045）有关。SDB（呼吸暂停低通气指数≥15/h）与左心室功能（EF：-4.12%，p=0.040；收缩末期容积：10.12ml，p=0.004）有关。控制肢端肥大症后，OAI（5.9[0.8，14.5]/h 和 1.7[0.2，5.1]/h，p=0.004）和夜间心率（66.1[59.2，69.8]bpm 和 61.7[54.0，67.2]bpm，p=0.025）下降，血压（DBP：78.0[70.3，86.0]mmHg 和 80.0[80.0，90.0]mmHg，p=0.012）升高。
肢端肥大症的合并症，包括睡眠呼吸障碍，似乎对活动期肢端肥大症的心血管重构有长期影响。未来的研究应探讨治疗 SDB 以降低肢端肥大症心血管风险的适用性。
