From the Guidelines
Patients with acromegaly should be routinely screened for Obstructive Sleep Apnea (OSA) and treated with continuous positive airway pressure (CPAP) therapy, as well as somatostatin analogs for acromegaly management, to improve morbidity, mortality, and quality of life outcomes. The high prevalence of OSA in acromegaly patients, estimated to be around 60-80%, is attributed to the excess growth hormone and IGF-1 causing soft tissue hypertrophy in the upper airway, macroglossia, and craniofacial changes that narrow the airway passage 1. Key considerations for managing these conditions include:
- Routine screening for OSA using polysomnography, even in asymptomatic patients
- First-line therapy for acromegaly with transsphenoidal surgery, followed by medical therapy with somatostatin analogs, such as octreotide or lanreotide
- CPAP therapy for OSA management, with individually titrated pressure settings
- Adjunctive measures, including weight management, positional therapy, and avoiding alcohol and sedatives before bedtime
- Regular follow-up sleep studies to assess the need for continued CPAP therapy or pressure adjustments, as OSA may persist even after biochemical control of acromegaly is achieved 1.
From the Research
OSA and Acromegaly: An Overview
- Obstructive sleep apnea (OSA) is a common complication in patients with acromegaly, a condition characterized by excess growth hormone production 2.
- The cause of OSA in acromegaly is believed to be related to osseous and soft-tissue changes surrounding the upper airway, leading to narrowing and collapse during sleep 2.
Treatment of OSA in Acromegaly
- Successful treatment of the primary disorder, acromegaly, can result in improved breathing during sleep in patients with OSA 2.
- Transsphenoidal hypophysectomy, a surgical procedure to remove the pituitary tumor, can resolve OSA in some patients 2.
- Medical treatment with somatostatin analogs, such as octreotide, can also improve OSA symptoms in patients with acromegaly 3.
- However, sleep apnea may persist despite normalization of growth hormone levels, or may improve markedly even with only partial biochemical remission 3.
Management of Acromegaly
- Early diagnosis and adequate treatment of acromegaly are essential to mitigate excess mortality associated with the condition 4.
- Pituitary surgery is generally the first-line therapy for patients with acromegaly, but medical therapies, including somatostatin receptor ligands and cabergoline, can be recommended for patients with persistent disease after surgery 4.
- Radiation therapy is usually a third-line option, and clinical, endocrine, imaging, histologic, and molecular markers may help predict the response to medical therapy 4.
Cardiovascular and Respiratory Complications
- Acromegaly is associated with various cardiovascular and respiratory complications, including sleep apnea, respiratory insufficiency, and cardiovascular disease 5.
- Treatment of acromegaly can improve some of these complications, such as left ventricular hypertrophy, hypertension, and obstructive sleep apnea 5.
- Strict control of the disease can reduce mortality and cardiovascular morbidity, reaching rates similar to those of the general population 5.