title: Increased neck soft tissue mass and worsening of obstructive sleep apnea after growth hormone treatment in men with abdominal obesity.
abstract: BACKGROUND
  Risk factors for obstructive sleep apnea (OSA) are male gender, obesity and abnormalities in neck soft tissue mass. OSA is associated with both growth hormone (GH) excess and severe GH deficiency in adults. Adults with abdominal obesity have markedly suppressed GH secretion.
  
  
  OBJECTIVE
  To study the effect of GH treatment on OSA in abdominally obese men with impaired glucose tolerance.
  
  
  METHODS
  Forty men with abdominal obesity and glucose intolerance were randomized in a prospective, 12-month double-blind trial to receive either GH or placebo. The treatment groups had similar BMI and waist circumference. Overnight polysomnography and computed tomography to assess muscle and fat distribution in the neck and abdomen were performed at baseline and after 12 months.
  
  
  RESULTS
  GH treatment increased insulin-like growth-factor-1i from (mean [SD]) 168 (72) to 292 (117) microg/L, the apnea-hypopnea index from (n/h) 31 (20) to 43 (25) and oxygen-desaturation index from (n/h) 18 (14) to 29 (21) (p = 0.0001, 0.001, 0.002). Neck transverse diameter, circumference and total cross-sectional area (p = 0.007, 0.01, 0.02) increased, while abdominal visceral adipose tissue (p = 0.007) was reduced. No between-group differences in total sleep time, REM sleep, NREM sleep, and time spent in supine position were found. The Epworth sleepiness scale score was unchanged.
  
  
  CONCLUSIONS
  GH treatment increased the severity of OSA in abdominally obese men. The possible mechanism appears to be reflected by the GH-induced increase of measures of neck volume. The present results, to some extent, argue against that low GH/IGF-I activity is a primary cause of OSA in abdominally obese men.
authors.affiliation: Sleep Laboratory, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. mahssa.karimi@lungall.gu.se
authors.forename: Mahssa
authors.initials: M
authors.lastname: Karimi
authors.forename: Josef
authors.initials: J
authors.lastname: Koranyi
authors.forename: Celina
authors.initials: C
authors.lastname: Franco
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Peker
authors.forename: Derek N
authors.initials: DN
authors.lastname: Eder
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Angelhed
authors.forename: Lars
authors.initials: L
authors.lastname: Lönn
authors.forename: Ludger
authors.initials: L
authors.lastname: Grote
authors.forename: Bengt-Ake
authors.initials: BA
authors.lastname: Bengtsson
authors.forename: Johan
authors.initials: J
authors.lastname: Svensson
authors.forename: Jan
authors.initials: J
authors.lastname: Hedner
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Johannsson
mesh_terms: D000328:Adult; D000368:Aged; D001823:Body Composition / Q000187:drug effects*; D001837:Body Weights and Measures / Q000379:methods; D004311:Double-Blind Method; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000097:blood; D019382:Human Growth Hormone / Q000009:adverse effects* / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging*; D056128:Obesity, Abdominal / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D017286:Polysomnography / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D011860:Radiography, Abdominal / Q000379:methods / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000139:chemically induced*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I