Increased neck soft tissue mass and worsening of obstructive sleep apnea after growth hormone treatment in men with abdominal obesity.
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.
Karimi
Mahssa
M
Sleep Laboratory, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. mahssa.karimi@lungall.gu.se
Koranyi
Josef
J
Franco
Celina
C
Peker
Yüksel
Y
Eder
Derek N
DN
Angelhed
Jan-Erik
JE
Lönn
Lars
L
Grote
Ludger
L
Bengtsson
Bengt-Ake
BA
Svensson
Johan
J
Hedner
Jan
J
Johannsson
Gudmundur
G
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
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I