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Endocrine Abstracts (2016) 41 GP167 | DOI: 10.1530/endoabs.41.GP167


1Umeå University Hospital, Umeå, Sweden; 2Uppsala University Hospital, Uppsala, Sweden; 3Karolinska University Hospital, Stockholm, Sweden; 4Sahlgrenska University Hospital, Gothenburg, Sweden; 5Linköping University Hospital, Linköping, Sweden; 6Örebro University Hospital, Örebro, Sweden; 7Skåne University Hospital, Malmö-Lund, Sweden.

Introduction: Patients with acromegaly have an increased mortality, mainly due to cardiovascular and respiratory diseases. Sleep apnea is related to hypertension, stroke and cardiovascular diseases and is reported to occur in 11–30% of acromegaly patients, according to retrospective studies based on diagnostic ICD-codes. However, in smaller prospective studies sleep apnea is found in about 70% of patients with active acromegaly and 40% after biochemical control. This difference raises the suspicion that sleep apnea may be an underdiagnosed complication of acromegaly.

Methods: This was a prospective cross-sectional multicenter study of 260 patients (128 women) with acromegaly registered in the Swedish Pituitary Registry. At a single outpatient visit (2013–2014), previous diagnosis and treatment for sleep apnea and cardiovascular diseases were assessed, data on smoking and anthropometry were collected, IGF1 concentrations were measured and the Epworth Sleepiness Scale was completed. Patients with clinical suspicion of undiagnosed sleep apnea were referred for sleep studies.

Results: 75/260 (29%) patients were previously diagnosed with sleep apnea. In 57% of these sleep apnea was diagnosed before acromegaly was diagnosed. After screening (Epworth Sleepiness Scale) and sleep studies, sleep apnea was found in another 20 (8%) patients, resulting in a total prevalence of 37%. The risk for sleep apnea (after adjustment for age and gender) was increased with higher BMI, IGF-1 and index finger circumference. Sleep apnea was not significantly associated with stroke/TIA, diabetes or hypertension.

Conclusion: Sleep apnea is a frequent complication in acromegaly related to overweight and IGF-1. Awareness of this complication is good in Sweden. However, a simple screening questionnaire and subsequent sleep study revealed previously undiagnosed sleep apnea in 8% of the patients. Screening for sleep apnea is recommended in acromegaly patients especially those with high BMI and IGF-1. In addition, collaboration between sleep clinics and endocrinology departments may enhance earlier diagnosis of acromegaly.

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