From the Guidelines
Patients with OSA and acromegaly typically experience significant improvement in their sleep-disordered breathing after successful adenoma resection, with approximately 50-75% of patients showing improvement in their OSA symptoms. Following surgery, the reduction in growth hormone and insulin-like growth factor-1 levels decreases soft tissue hypertrophy in the upper airway, contributing to obstruction, although the provided evidence does not directly address this topic 1. The benefits of exercise and weight management are well established in improving general health and OSA severity, as noted in the American Thoracic Society clinical practice guideline 1. Key factors affecting outcomes after adenoma resection include:
- Disease duration before treatment
- Severity of acromegalic changes
- Presence of irreversible structural changes
- Comorbidities like obesity Patients should continue using CPAP therapy until post-operative sleep studies confirm improvement, typically conducted 3-6 months after surgery, and may require ongoing CPAP therapy or additional interventions like weight management to fully control their OSA symptoms. It is essential to consider the benefits of exercise and increased physical activity in improving general health, including blood pressure, as highlighted in the guideline 1. However, the specific effects of adenoma resection on OSA symptoms in patients with acromegaly are not directly addressed in the provided evidence, and the recommendation is based on the general understanding of the condition and its treatment.
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 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.