IGF-1-based screening reveals a low prevalence of acromegaly in patients with obstructive sleep apnea
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Recent epidemiologic studies suggest a high prevalence of acromegaly. The prevalence of obstructive sleep apnea syndrome (OSAS) in acromegaly patients ranges from 47 to 70%. A recent study identified 2 patients with acromegaly among 567 OSAS patients. However, it remains unclear whether screening for acromegaly among OSAS patients is necessary. The aim was to screen for acromegaly among OSAS patients by measuring IGF-1 levels and performing confirmatory tests if necessary.
We performed a prospective cross-sectional diagnostic study on the prevalence of acromegaly in patients with OSAS. A total of 507 patients with a confirmed diagnosis of OSAS (357 male, 150 female) were screened.
Seven male and three female patients (1.97% of total) were positively screened for elevated IGF-1 levels. Nine out of ten patients suppressed growth hormone levels during OGTT excluding acromegaly, whereas one individual was identified to have acromegaly according to established criteria (1/507, prevalence 0.2%). Analysis of the data showed no correlation between elevated IGF-1 values and the severity of OSAS or BMI.
Our data demonstrate a low prevalence of acromegaly in patients with OSAS. Until data from population-based studies is available we suggest restricting screening for acromegaly in OSAS to those patients who have additional clinical features of acromegaly.
KeywordsAcromegaly Obstructive sleep apnea Growth hormone OSAS IGF-1
We thank Sandra Rutz for helping to organize and coordinate the research study.
The study was supported by a research grant from Pfizer.
D.H. analyzed the data and wrote the manuscript. C.R. performed the research and analyzed the data. M.B. and A.T. helped to conceptualize the structure of the study and helped to perform the study. R.F. contributed to the execution of the research. M.B. supervised laboratory analysis. R.P.K. contributed to writing the manuscript. J.S. and M.R. helped to conceptualize the structure of the study. H.J.S. acted in an advisory role, designed the research study, helped analyze the data and contributed to writing the manuscript. All authors revised it critically for important intellectual content and gave final approval for publication.
Compliance with ethical standards
Conflict of interest
H.J.S. received research grants, speaker fees, and travel grants from Pfizer, and speaker fees and travel grants from Novartis. M.R. received speaker fees from Pfizer, Ipsen, and Novartis. J.S. has received research grants, lecture fees and travel/accommodation/meeting expenses from Ipsen, Novartis, and Pfizer. The remaining authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 11.S. Melmed, F.F. Casanueva, A. Klibanski, M.D. Bronstein, P. Chanson, S.W. Lamberts, C.J. Strasburger, J.A. Wass, A. Giustina, A consensus on the diagnosis and treatment of acromegaly complications. Pituitary 16(3), 294–302 (2013). https://doi.org/10.1007/s11102-012-0420-x CrossRefPubMedGoogle Scholar
- 13.E. Kuhn, L. Maione, A. Bouchachi, M. Roziere, S. Salenave, S. Brailly-Tabard, J. Young, P. Kamenicky, P. Assayag, P. Chanson, Long-term effects of pegvisomant on comorbidities in patients with acromegaly: a retrospective single-center study. Eur. J. Endocrinol. 173(5), 693–702 (2015). https://doi.org/10.1530/EJE-15-0500 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.M.V. Davi, L. Dalle Carbonare, A. Giustina, M. Ferrari, A. Frigo, V. Lo Cascio, G. Francia, Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease. Eur. J. Endocrinol. 159(5), 533–540 (2008). https://doi.org/10.1530/EJE-08-0442 CrossRefPubMedGoogle Scholar
- 16.P. Petrossians, A.F. Daly, E. Natchev, L. Maione, K. Blijdorp, M. Sahnoun-Fathallah, R. Auriemma, A.M. Diallo, A.L. Hulting, D. Ferone, V. Hana Jr., S. Filipponi, C. Sievers, C. Nogueira, C. Fajardo-Montanana, D. Carvalho, V. Hana, G.K. Stalla, M.L. Jaffrain-Rea, B. Delemer, A. Colao, T. Brue, S. Neggers, S. Zacharieva, P. Chanson, A. Beckers, Acromegaly at diagnosis in 3173 patients from the Liege Acromegaly Survey (LAS) Database. Endocr. Relat. Cancer 24(10), 505–518 (2017). https://doi.org/10.1530/ERC-17-0253 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.L.M. Galerneau, J.L. Pepin, A.L. Borel, O. Chabre, M. Sapene, B. Stach, J. Girey-Rannaud, N. Arnol, R. Tamisier, P. Caron; scientific council, investigators of the French national sleep apnoea registry, Acromegaly in sleep apnoea patients: a large observational study of 755 patients. Eur. Respir. J. 48(5), 1489–1492 (2016). https://doi.org/10.1183/13993003.01229-2016 CrossRefPubMedGoogle Scholar
- 19.G. Sesmilo, E. Resmini, M. Sambo, C. Blanco, F. Calvo, F. Pazos, P. Fernandez-Catalina, P. Martinez de Icaya, C. Paramo, C. Fajardo, M. Marazuela, C. Alvarez-Escola, J.J. Diez, V. Perea; group, A.s., Prevalence of acromegaly in patients with symptoms of sleep apnea. PLoS. ONE. 12(9), e0183539 (2017). https://doi.org/10.1371/journal.pone.0183539 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.L.J. Epstein, D. Kristo, P.J. Strollo Jr., N. Friedman, A. Malhotra, S.P. Patil, K. Ramar, R. Rogers, R.J. Schwab, E.M. Weaver, M.D. Weinstein; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine, Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J. Clin. Sleep. Med. 5(3), 263–276 (2009).PubMedGoogle Scholar
- 22.C.L. Rosen, D. Auckley, R. Benca, N. Foldvary-Schaefer, C. Iber, V. Kapur, M. Rueschman, P. Zee, S. Redline, A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Sleep 35(6), 757–767 (2012). https://doi.org/10.5665/sleep.1870 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.M. Bidlingmaier, N. Friedrich, R.T. Emeny, J. Spranger, O.D. Wolthers, J. Roswall, A. Korner, B. Obermayer-Pietsch, C. Hubener, J. Dahlgren, J. Frystyk, A.F. Pfeiffer, A. Doering, M. Bielohuby, H. Wallaschofski, A.M. Arafat, Reference intervals for insulin-like growth factor-1 (igf-i) from birth to senescence: results from a multicenter study using a new automated chemiluminescence IGF-I immunoassay conforming to recent international recommendations. J. Clin. Endocrinol. Metab. 99(5), 1712–1721 (2014). https://doi.org/10.1210/jc.2013-3059 CrossRefPubMedGoogle Scholar
- 27.M. Reincke, S. Petersenn, M. Buchfelder, B. Gerbert, G. Skrobek-Engel, H. Franz, R. Lohmann, H.J. Quabbe, The German acromegaly registry: description of the database and initial results. Exp. Clin. Endocrinol. Diabetes 114(9), 498–505 (2006). https://doi.org/10.1055/s-2006-948313 CrossRefPubMedGoogle Scholar
- 28.J. Roemmler, B. Gutt, R. Fischer, S. Vay, A. Wiesmeth, M. Bidlingmaier, J. Schopohl, M. Angstwurm, Elevated incidence of sleep apnoea in acromegaly-correlation to disease activity. Sleep. & breathing = Schlaf & Atm. 16(4), 1247–1253 (2012). https://doi.org/10.1007/s11325-011-0641-7 CrossRefGoogle Scholar
- 29.H.J. Schneider, B. Saller, J. Klotsche, W. Marz, W. Erwa, H.U. Wittchen, G.K. Stalla, Opposite associations of age-dependent insulin-like growth factor-I standard deviation scores with nutritional state in normal weight and obese subjects. Eur. J. Endocrinol. 154(5), 699–706 (2006). https://doi.org/10.1530/eje.1.02131 CrossRefPubMedGoogle Scholar