Endocrinol Metab.  2024 Aug;39(4):641-652. 10.3803/EnM.2024.1933.

Obstructive Sleep Apnea Screening and Effects of Surgery in Acromegaly: A Prospective Study

• Cho J
• Kim JH
• Kim YH
• Lee J

• KMID: 2558948
• DOI: http://doi.org/10.3803/EnM.2024.1933

Abstract

Background
To identify a screening tool for obstructive sleep apnea (OSA) and evaluate the effects of endoscopic transsphenoidal surgery on improving OSA in patients with acromegaly.
Methods
We prospectively enrolled adults with acromegaly scheduled for endoscopic transsphenoidal surgery. All measurements were conducted when participants were admitted for a baseline work-up for acromegaly before surgery and surveillance approximately 3 to 6 months after surgery. Respiratory event index (REI) was used as a surrogate for apnea-hypopnea index (Trial Registration: NCT03526016).
Results
Of the 35 patients with acromegaly (median age, 47 years; 40% men; median body mass index, 24.4 kg/m²), 24 (68.6%) had OSA (REI ≥5/hour), 15 (42.9%) had moderate-to-severe OSA (REI ≥15/hour). At baseline, serum insulin-like growth factor 1 (IGF-1) levels were positively correlated with the REI (ρ=0.53, P=0.001). The sensitivity and negative predictive value of a Snoring, Tiredness, Observed apnea, high blood Pressure-Body mass index, age, Neck circumference, and Gender (STOP-Bang) score ≥ 3 were 93.3% and 87.5%, respectively, detecting moderate-to-severe OSA. Biochemical acromegaly remission was achieved in 32 (91.4%) patients. The median difference in the REI was –9.5/hour (95% confidence interval, –13.3 to –5.3). Half of the 24 patients diagnosed with OSA preoperatively had REI <5/hour postoperatively. In a linear mixed-effects model, changes in the REI across surgery were related to changes in IGF-1 levels.
Conclusion
The STOP-Bang questionnaire is a reliable tool for OSA among patients with acromegaly. Improvement in OSA severity after surgery is related to decreased IGF-1 levels.

Keyword

Acromegaly; Endoscopic transsphenoidal surgery; Sleep apnea, obstructive; Respiratory polygraphy; Screening

Figure

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  Fig. 1. Correlation between sleep parameters and insulin-like growth factor 1 (IGF-1) levels before endoscopic transsphenoidal surgery (n=35). (A) Respiratory event index (REI), (B) oxygen desaturation index (ODI), (C) sleep time spent with oxygen saturation >90% (TS90), (D) mean oxygen saturation (SpO2), and (E) lowest SpO2. ULN, upper limit of normal.

• 

  Fig. 2. Changes in clinical parameters after endoscopic transsphenoidal surgery (n=35). (A) Respiratory event index (REI), (B) oxygen desaturation index (ODI), (C) sleep time spent with oxygen saturation <90% (TS90), (D) mean oxygen saturation (SpO2), (E) lowest SpO2, (F) Epworth Sleepiness Scale, (G) weight, and (H) insulin-like growth factor 1 (IGF-1). CI, confidence interval; ULN, upper limit of normal.

• 

  Fig. 3. Median differences of the respiratory event index (REI) after endoscopic transsphenoidal surgery according to subgroups. Weight gain was defined as an increase of ≥3% compared with before surgery, weight loss as a decrease of ≥3%, and stable weight as change in weight between these values. CI, confidence interval; BMI, body mass index; IGF-1, insulin-like growth factor 1; ULN, upper limit of normal.

• 

  Fig. 4. Repeated measures correlation between respiratory event index (REI) and (A) weight, (B) neck circumference, (C) growth hormone (GH), and (D) insulin-like growth factor 1 (IGF-1) level. ULN, upper limit of normal.

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