Objective: To conduct a systematic review and meta-analysis of observational, cross sectional and longitudinal studies of sleep apnoea syndrome in acromegalic subjects to determine a) prevalence b) effect of treatment and c) relationship to GH and/or IGF-1.
Method: A PubMed search using (acromegaly) AND (sleep apnoea) as search terms was performed with subsequent hand searching of relevant papers. Cross sectional and longitudinal studies were included that contained original data and were assessed in relation to the Strobe statement on data extraction.
Measurements: Collected data included patient demographics, acromegaly status, (whether active/treated/in remission) sleep apnoea status and severity, and their definitions. Values for GH and IGF-1 were all adjusted to mcg/L.
Results: We identified 11 relevant studies from 120 papers in total, (three longitudinal). In a total of 321 patients (58% male), there was a 55% prevalence of sleep apnoea syndrome by objective testing. Sleep apnoea was more common in male patients (58%) compared to female (42%) (P≤0.01) using chi squared test. Patients with sleep apnoea had a higher mean GH 29.68 mcg/L (95% CI; 3.756.1) vs 17.05 mcg/L (95% CI; 6.5727.51) where this was reported. IGF-1 tended to be higher amongst patients with sleep apnoea syndrome. In three longitudinal studies where polysomnography was repeated (n=57) sleep apnoea resolved in one and improved in four subjects.
Conclusion: Patients with acromegaly (particularly males) have a high prevalence of sleep apnoea which may not be necessarily recognized by symptoms alone. GH and IGF-1 were higher in those with sleep apnoea. Screening for sleep apnoea should be offered to all acromegalic subjects irrespective of symptoms or disease status and better prospective data are required to demonstrate a convincing effect of treatment.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.