Journal of Endocrinological Investigation

, Volume 34, Issue 1, pp 60–64 | Cite as

Assessment of the awareness and management of sleep apnea syndrome in acromegaly. The COM.E.TA (Comorbidities Evaluation and Treatment in Acromegaly) Italian Study Group

  • E. De Menis
  • A. Giustina
  • A. Colao
  • E. Degli Uberti
  • E. Ghigo
  • F. Minuto
  • F. Bogazzi
  • R. Drigo
  • A. Cattaneo
  • G. Aimaretti
  • COM.E.T.A. (COMorbidities Evaluation and Treatment in Acromegaly) Italian Study Group
Original Articles


In 2007 the Italian COM.E.T.A. (COMorbidities Evaluation and Treatment in Acromegaly) study group started to assess the application in a clinical setting of the Versailles criteria for management of acromegaly complications by a first questionnaire focusing on cardiovascular co-morbidities. A further questionnaire on sleep apnea syndrome (SAS) was delivered by the COM.E.T.A. study group to 107 endocrine centers in Italy. The results of our survey suggest that SAS is a well-known comorbidity even if its estimated prevalence is lower than in the literature. Polysomnography is the preferred tool for diagnosis. Control of SAS is considered relevant both for quality of life and co-morbidities. Continuous positive airway pressure is the cornerstone of therapy, but patients’ acceptance may be critical. Control of GH/IGF-I secretion is important to improve SAS. Management of SAS requires cooperation between specialists.


Acromegaly sleep apnea syndrome somatostatin analogs 


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  1. 1.
    Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 2004, 25: 102–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Giustina A, Casanueva FF, Cavagnini F, et al; The Pituitary Society and The Euopean Neuroendocrine Association. Diagnosis and treatment of acromegaly complications. J EndocrinoI Invest 2003, 26: 1242–7.Google Scholar
  3. 3.
    Giustina A., Mancini T, Boscani PF, et al; COM.E.T.A. (COMorbidities Evaluation and Treatment inAcromegaly) Italian Study Group. Assessment of the awareness and management of cardiovascular complications of acromegaly in Italy. The COM.E.TA (COMorbidities Evaluation and Treatment in Acromegaly) Study. J Endocrinol Invest 2008, 31: 1–8.CrossRefGoogle Scholar
  4. 4.
    Grunstein RR, Ho KY, Sullivan CE. Sleep apnea in acromegaly. Ann Intern Med 1991, 115: 527–32.PubMedCrossRefGoogle Scholar
  5. 5.
    Grunstein RR, Ho KK, Sullivan CE. Effect of octreotide, a somatostatin analog, on sleep apnea in patients with acromegaly. Ann Intern Med 1994, 121: 478–83.PubMedCrossRefGoogle Scholar
  6. 6.
    Pelttari L, Polo O, Rauhala E, et al. Nocturnal breathing abnormalities in acromegaly after adenomectomy. Clin Endocrinol (Oxf) 1995, 43: 175–82.CrossRefGoogle Scholar
  7. 7.
    Rosenow F, Reuter S, Deuss U, et al. Sleep apnoea in treated acromegaly: relative frequency and predisposing factors. Clin Endocrinol 1996, 45: 563–9.CrossRefGoogle Scholar
  8. 8.
    Hochban W, Ehlenz K, Conradt R, Brandenburg U. Obstructive sleep apnoea in acromegaly: the role of craniofacial changes. Eur Respir J 1999, 14: 196–202.PubMedCrossRefGoogle Scholar
  9. 9.
    Saeki N, Isono S, Nishino T, Iuchi T, Yamaura A. Sleep-disordered breathing in acromegalics—relation of hormonal levels and quantitative sleep study by means of bedside oximeter. Endocr J 1999, 46: 585–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Weiss V, Sonka K, Pretl M, et al. Prevalence of sleep apnea syndrome in acromegaly population. J Endocrinol Invest 2000; 23: 515–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Ip MS, Tan KC, Peh WC, Lam KS. Effect of Sandostatin LAR on sleep apnoea in acromegaly: correlation with computerized tomographic cephalometry and hormonal activity. Clin Endocrinol (Oxf) 2001, 55: 477–83.CrossRefGoogle Scholar
  12. 12.
    Dostalova S, Sonka K, Smahel Z, Weiss V, Marek J, Horinek D. Craniofacial abnormalities and their relevance for sleep apnoea syndrome aetiopathogenesis in acromegaly. Eur J Endocrinol 2001, 144: 491–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Herrmann BL, Wessendorf TE, Ajaj W, Kahlke S, Teschler H, Mann K. Effects of octreotide on sleep apnoea and tongue volume (magnetic resonance imaging) in patients with acromegaly. Eur J Endocrinol 2004, 151: 309–15.PubMedCrossRefGoogle Scholar
  14. 14.
    Sze L, Schmid C, Bloch KE, Bernays R, Brändle M. Effect of transsphenoidal surgery on sleep apnoea in acromegaly. Eur J Endocrinol 2007, 156: 321–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Davì MV, Dalle Carbonare L, Giustina A, et al. Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease. Eur J Endocrinol 2008, 159: 533–40.PubMedCrossRefGoogle Scholar
  16. 16.
    van Haute FR, Taboada GF, Corrêa LL, et al. Prevalence of sleep apnea and metabolic abnormalities in patients with acromegaly and analysis of cephalometric parameters by magnetic resonance imaging. Eur J Endocrinol 2008, 158: 459–65.PubMedCrossRefGoogle Scholar
  17. 17.
    Berg C, Wessendorf TE, Mortsch F, et al. Influence of disease control with pegvisomant on sleep apnoea and tongue volume in patients with active acromegaly. Eur J Endocrinol 2009, 161: 829–35.PubMedCrossRefGoogle Scholar
  18. 18.
    Attal P, Chanson P. Endocrine aspects of obstructive sleep apnea. J Clin Endocrinol Metab 2010, 95: 483–95.PubMedCrossRefGoogle Scholar
  19. 19.
    Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: phathophysiology and diagnosis. Chest 2007, 132: 325–37.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Collop NA, Anderson WM, Boehlecke B, et al; Portable monitoring task force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patient. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2007, 3: 737–47.PubMedGoogle Scholar
  21. 21.
    Commissione paritetica AIPO-AIMS. Linee guida di procedura diagnostica nella sindrome delle apnee ostruttive dell’adulto. Rassegna di Patologia dell’Apparato respiratorio 2001, 16: 278–80.Google Scholar
  22. 22.
    Chervin RD, Murman DL, Malow BA, Totten V. Cost-utility of three approaches to the diagnosis of sleep apnea: polysomnography, home testing, and empirical therapy. Ann Intern Med 1999, 130: 496–505.PubMedCrossRefGoogle Scholar
  23. 23.
    Fleetham J, Ayas N, Bradley D, et al; CTS Sleep Disordered Breathing Committee. Canadian Thoracic Society guidelines: diagnosis and treatment of sleep disordered breathing in adults. Can Respir J 2006, 13: 387–92.PubMedCentralPubMedGoogle Scholar
  24. 24.
    Melmed S. Medical progress: acromegaly. N Engl J Med 2006, 355: 2558–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Colao A, Terzolo M, Bondanelli M, et al. GH and IGF-I excess control contributes to blood pressure control: results of an observational, retrospective, multicentre study in 105 hypertensive acromegalic patients on hypertensive therapy. Clin Endocrinol 2008, 69: 613–20.CrossRefGoogle Scholar
  26. 26.
    Calhoun DA, Jones D, Textor S, et al; American Heart Association Professional Education Committee. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008, 117: e510–26.PubMedCrossRefGoogle Scholar
  27. 27.
    Lanfranco F, Motta G, Minetto MA, Ghigo E, Maccario M. Growth hormone/insulin-like growth factor-I axis in obstructive sleep apnea syndrome: an update. J Endocrinol Invest 2010, 33: 192–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Mazziotti G, Floriani I, Bonadonna S, Torri V, Chanson P, Giustina A. Effects of somatostatin analogs on glucose homeostasis: a metaanalysis of acromegaly studies. J Clin Endocrinol Metabol 2009, 94: 1500–8.CrossRefGoogle Scholar
  29. 29.
    Sardella C, Lombardi M, Rossi G, et al. Short- and long-term changes of quality of life in patients with acromegaly: results from a prospective study. J Endocrinol Invest 2010, 33: 20–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Perez de Llano LA, Golpe R, Ortiz Piquer M, et al. Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest 2005, 128: 587–94.PubMedCrossRefGoogle Scholar
  31. 31.
    Kushida CA, Chediak A, Berry RB, et al; Positive airway pressure titration task force; American Academy of Sleep Medcine. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 2008, 4: 157–71.PubMedGoogle Scholar
  32. 32.
    Melmed S, Colao A, Barkan A, et al; Acromegaly Consensus Group. Guidelines for acromegaly management: an update. J Clin Endocrinol Metabol 2009, 94: 1509–17.CrossRefGoogle Scholar
  33. 33.
    De Marinis L, Bianchi A, Mazziotti G, et al. The long-term cardiovascular outcome of different GH-lowering treatments in acromegaly. Pituitary 2008, 11: 13–20.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2011

Authors and Affiliations

  • E. De Menis
    • 1
  • A. Giustina
    • 2
  • A. Colao
    • 3
  • E. Degli Uberti
    • 4
  • E. Ghigo
    • 5
  • F. Minuto
    • 6
  • F. Bogazzi
    • 7
  • R. Drigo
    • 8
  • A. Cattaneo
    • 9
  • G. Aimaretti
    • 10
  • COM.E.T.A. (COMorbidities Evaluation and Treatment in Acromegaly) Italian Study Group
  1. 1.Department of Internal MedicineGeneral HospitalMontebellunaItaly
  2. 2.University of BresciaBresciaItaly
  3. 3.University of NaplesNaplesItaly
  4. 4.University of FerraraFerraraItaly
  5. 5.University of TurinTurinItaly
  6. 6.University of GenovaGenovaItaly
  7. 7.University of PisaPisaItaly
  8. 8.General HospitalFeltreItaly
  9. 9.Ipsen S.p.a.Italy
  10. 10.University “A. Avogadro” of Piemonte OrientaleNovaraItaly

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