From the Guidelines
After adenoma resection in patients with both obstructive sleep apnea (OSA) and acromegaly, most patients can expect significant improvement in their sleep apnea symptoms, but the degree of improvement varies and is influenced by factors such as the completeness of tumor removal and pre-existing conditions like obesity. The improvement in OSA symptoms is primarily due to the normalization of growth hormone and insulin-like growth factor-1 (IGF-1) levels, which reverses soft tissue swelling in the upper airway, reduces tongue volume, and improves craniofacial structural abnormalities that contributed to airway obstruction during sleep. However, the provided evidence 1 focuses on the role of weight management in the treatment of adult obstructive sleep apnea, suggesting that while exercise and increased physical activity may lead to minimal improvement in sleep quality, they are associated with overall health benefits, including improved blood pressure.
Key factors influencing the outcome after adenoma resection include:
- The completeness of tumor removal
- Duration of acromegaly before treatment
- Severity of pre-existing OSA
- Presence of other risk factors like obesity
- Extent of skeletal alterations versus soft tissue changes
Post-operatively, it is crucial for patients to continue using their CPAP therapy until a formal reassessment of their OSA status through polysomnography, typically scheduled 3-6 months after surgery 1. Even with successful tumor resection, some patients may require ongoing CPAP therapy or additional treatments. The evidence from 1 highlights the importance of considering overall health benefits beyond OSA-specific outcomes when managing patients with OSA, particularly those who are overweight or obese.
In clinical practice, the management of patients with OSA and acromegaly after adenoma resection should prioritize a comprehensive approach, including monitoring for improvements in OSA symptoms, adjusting CPAP therapy as needed, and promoting lifestyle modifications such as diet and exercise to enhance overall health and well-being.
From the Research
Effects of Adenoma Resection on OSA and Acromegaly
- Patients with obstructive sleep apnea (OSA) and acromegaly may experience improvement in their sleep apnea symptoms after adenoma resection, as shown in studies 2, 3, 4, 5.
- The improvement in OSA symptoms is believed to be related to the reduction in growth hormone levels after adenoma resection, which can lead to a decrease in the size of the upper airway tissues and subsequent reduction in airway obstruction 2, 3, 4.
- Studies have reported that a significant proportion of patients with OSA and acromegaly experience a cure or significant improvement in their OSA symptoms after adenoma resection, with reported cure rates ranging from 68.8% to 100% 3, 4, 5.
- The use of polysomnography (PSG) to diagnose and monitor OSA in patients with acromegaly is recommended, as it can help to identify patients who are at risk of developing OSA and monitor the effectiveness of treatment 3, 4.
Treatment Outcomes
- Transsphenoidal hypophysectomy alone has been shown to be effective in resolving sleep apnea syndrome in some patients with acromegaly 2.
- Endoscopic transsphenoidal surgery has also been shown to be effective in improving OSA symptoms in patients with acromegaly, with a significant reduction in the respiratory event index (REI) reported in one study 4.
- The STOP-Bang questionnaire has been identified as a reliable tool for screening for OSA in patients with acromegaly, with a high sensitivity and negative predictive value for detecting moderate-to-severe OSA 4.