SFEBES2007 Poster Presentations Neuroendocrinology and behaviour (including pituitary) (27 abstracts)
Sleep disorders and response to treatment in the ‘Acromegalic cardiovascular and respiratory outcomes with primary analogue therapy (ACROPAT)’ trial
Alison Webb 1 , Sam Pilsworth 2 , Sam O’Toole 1 , Chris Strey 1 , Shaumya Ariyaratnam 1 , Emad George 3 , Joohi Majeed 4 , Alison Melvin 5 , Nick Morrish 5 , Jonathan Roland 6 , Ian Smith 2 , Diana Wood 1 , Krishna Chatterjee 1 , Helen Simpson 1 , John Shneerson 2 & Mark Gurnell 1
1Department of Endocrinology, Addenbrooke’s Hospital, Cambridge, United Kingdom; 2Respiratory Support & Sleep Centre, Papworth Hospital, Papworth Everard, United Kingdom; 3Queen Elizabeth Hospital, Kings Lynn, United Kingdom; 4West Suffolk Hospital, Bury St Edmunds, United Kingdom; 5Bedford Hospital, Bedford, United Kingdom; 6Peterborough District Hospital, Peterborough, United Kingdom.
Respiratory disorders are a major cause of illness and impaired physical function in patients with acromegaly, contributing to 25% of all recorded deaths, with respiratory mortality 3-fold higher than in normal subjects. Sleep apnoea (SA), the phenomenon of recurrent cessation or decrease of airflow to the lungs during sleep, is the commonest reported respiratory complication. Both obstructive (OSA) and central (CSA) sleep apnoeas are known to occur, although the overall prevalence of SA (and relative contributions of OSA and CSA) varies widely from cohort to cohort, reflecting heterogeneous study populations, many of which include both newly diagnosed and previously treated acromegalics.
Here, we report the extent and nature of sleep disturbance (defined according to the International Classification of Sleep Disorders [2005], and assessed using polysomnography), in an unselected group of newly diagnosed acromegalic subjects (n=14; 7 males, 7 females; mean age 58.9 years, range 25–74) recruited to the ACROPAT trial. In this study, previously untreated acromegalics were assessed for evidence of cardiovascular (hypertension, left ventricular hypertrophy/dysfunction, impaired endothelial function, arterial stiffness) and respiratory (OSA, CSA) sequelae at diagnosis, and then again at 6 months post-treatment with the somatostatin analogue Lanreotide Autogel® (LA).
Mean growth hormone levels in the cohort as a whole were 39.8±8.6 mU/L (mean±sem) at presentation, and fell to 13.1±3.8 mU/L after 6 months of LA therapy (P=0.01). A parallel decline in serum IGF1 was also noted from 102.0 to 58.9 nmol/L (P=0.0001). 7 subjects (50%) achieved mean GH levels of <5 mU/L and/or normal age- and sex-matched IGF1 levels. At baseline 10 subjects (71.4%) were recorded to have significant sleep disordered breathing (7 OSA, 2 CSA, and 1 mixed OSA/CSA). In 10 subjects with an elevated desaturation index (DI=number of ≥4% arterial desaturations/hr) at baseline, all showed a reduction following LA therapy (basal 21.9±4.85; follow-up 12.2±4.99 [mean±sem]; P=0.005). Eight subjects had a raised apnoea/hypopnoea index (AHI=apnoeic+hypopnoeic episodes/hr) at presentation, and following treatment this also decreased (basal AHI 32.9±4.47; follow-up 21.8±5.16 [mean±sem]; P=0.07). Subjective sleepiness (Epworth Sleepiness Score) also improved.
Thus, sleep disordered breathing is a common finding in newly presenting acromegalic subjects, and primary medical therapy with LA is associated with improvements in both subjective and objective indices of sleep disturbance.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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