Mickelson S A, Rosenthal L D, Rock J P, Senior B A, Friduss M E
Department of Otolaryngology, Henry Ford Hospital, Detroit, MI 48202.
Otolaryngol Head Neck Surg. 1994 Jul;111(1):25-30. doi: 10.1177/019459989411100107.
Obstructive sleep apnea syndrome is a complex disorder that has been associated with a variety of abnormalities of the upper airway, including tonsil and adenoid hypertrophy, nasal obstruction, retrognathia, and macroglossia. The cause of the airway obstruction in acromegaly is believed to be related to osseous and soft-tissue changes surrounding the upper airway, which lead to narrowing and subsequent collapse during sleep. We describe the results of treatment in seven patients with both sleep apnea and acromegaly. Four patients were treated by transsphenoidal hypophysectomy alone with a resolution of sleep apnea syndrome. One underwent hypophysectomy followed by postoperative radiation therapy, which reduced his apnea. Three patients underwent unsuccessful uvulopalatopharyngoplasty. Successful treatment of the primary disorder, in this case acromegaly, resulted in improved breathing during sleep in five patients. This series would suggest that acromegalic patients with sleep apnea should be treated for their pituitary tumor to reduce growth hormone before consideration of surgery to enlarge or bypass the upper airway.
阻塞性睡眠呼吸暂停综合征是一种复杂的疾病，与多种上呼吸道异常有关，包括扁桃体和腺样体肥大、鼻阻塞、下颌后缩和巨舌症。肢端肥大症患者气道阻塞的原因被认为与上呼吸道周围的骨质和软组织变化有关，这些变化导致睡眠期间气道变窄并随后塌陷。我们描述了7例同时患有睡眠呼吸暂停和肢端肥大症患者的治疗结果。4例患者仅接受经蝶窦垂体切除术，睡眠呼吸暂停综合征得到缓解。1例患者接受了垂体切除术，随后进行术后放射治疗，其呼吸暂停症状减轻。3例患者接受悬雍垂腭咽成形术但未成功。对原发性疾病（在本例中为肢端肥大症）的成功治疗，使5例患者的睡眠呼吸得到改善。该系列病例表明，患有睡眠呼吸暂停的肢端肥大症患者在考虑进行扩大或绕过上呼吸道的手术之前，应先治疗垂体肿瘤以降低生长激素水平。
