title: Morphological study of upper airways and long-term follow-up of obstructive sleep apnea syndrome in acromegalic patients.
abstract: Pathogenesis and long-term outcome of obstructive sleep apnea syndrome (OSAS) in acromegalic patients are still under debate. The aim of the study was to assess the prevalence and long-term follow-up of a series of acromegalic patients with OSAS and to investigate site, degree, and possible causes of upper airway obstruction by morphological study. Cross-sectional and longitudinal study was conducted in 58 acromegalic patients (33 active, 25 controlled) with polysomnography in all subjects, repeated in 25 patients with OSAS, and echocardiography. Morphological study including fiberoptic nasopharyngoscopy with the Müller maneuver (FNMM), magnetic resonance imaging (MRI), with 3-dimensional (3D) elaboration was also performed. The prevalence of OSAS was 58.6 % in the whole series: 63.6 % in the active group and 52 % in the controlled one. Left ventricular hypertrophy was more prevalent in patients with OSAS. OSAS improved in 62.5 % of active patients after achieving hormonal control, whereas it persisted or got worse in 66.6 % of the controlled ones. The uvula and tongue base were the main site of obstruction assessed by FNMM. Uvula diameters obtained by MRI study correlated with the severity of upper airway collapse assessed by FNMM and tongue measure with apnea-hypopnea index (p = 0.044). A greater narrowing and a smaller total volume of upper airways were confirmed by 3D-MRI in patients with more severe OSAS. Uvula and tongue hypertrophy plays a relevant role in the pathogenesis and severity of OSAS. Intensive treatment of acromegaly needs to be promptly adopted in order to reverse it.
authors.affiliation: Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Castellani
authors.affiliation: Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Francia
authors.affiliation: Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Dalle Carbonare
authors.affiliation: Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: ENT Department, University of Verona, Verona, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Viva
authors.affiliation: Department of Radiology, University of Verona, Verona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cerini
authors.affiliation: Department of Radiology, University of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zaccarella
authors.affiliation: Department of Dentistry and Maxillo Facial Surgery, University of Verona, Verona, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Trevisiol
authors.affiliation: Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy. mariavittoria.davi@ospedaleuniverona.it.
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Davi'
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000473:pathology*; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D014059:Tongue / Q000473:pathology*; D014609:Uvula / Q000473:pathology*
keywords: Acromegaly; IGF-1; Pathogenesis; Sleep apnea syndrome