Does hormonal control obviate positive airway pressure therapy in acromegaly with sleep-disordered breathing?

SummaryIntroductionAcromegaly is a disease in which uncontrolled release of growth hormone occurs after closure of epiphyseal plates, causing changes in the body that can lead to sleep disordered breathing (SDB). No definite guidelines regarding the treatment of SDB in acromegaly are available. In this study, we aimed to investigate the prevalence of SDB in acromegaly and whether hormonal control alters the necessity of positive airway pressure (PAP) therapy in acromegaly patients with SDB.MethodsForty-two acromegaly patients were included in the study and divided into two groups according to disease status, i.e., active or well controlled. All patients underwent polysomnography. Fourteen patients with active acromegaly were diagnosed with SDB and were evaluated for PAP therapy with polysomnography both before and 6 months after disease control was achieved.ResultsSleep-disorder breathing was diagnosed in 22 of 42 patients, 7 of 20 patients with controlled-disease and 15 of 20 patients with active diseases. There were significant reductions in respiratory disturbance index (RDI), apnea index, desaturation index, central apnea number, and rapid eye movement-phase RDI at the control polysomnography. Initially, PAP therapy was indicated in 12 of 14 patients and PAP therapy indication held in 11 patients after acromegaly control was achieved.ConclusionOur study revealed that over half of patients with acromegaly had SDB. Furthermore, SDB severity decreases with acromegaly treatment; however, this decrease does not change the indication for PAP therapy; therefore, PAP therapy should not be delayed in acromegalic SDB patients

Effects of body position on sleep architecture and quality in subsyndromal adults without apparent obstructive sleep apnea

There is a well-known relationship between sleep quality and body position during sleep in patients with obstructive sleep apnea (OSA). In this study, we aimed to investigate the effects of body position on sleep architecture and sleep quality in subjects without sleep apnea. One hundred and one subjects between 24 and 77 years of age, who had undergone polysomnography and had a respiratory disturbance index (RDI) below 5 were included in the study. Sleep stages and sleep parameters in the right, left, supine and prone positions were examined. Mean sleep duration in S2, S3 and rapid eye movement (REM) were 110, 39 and 20.7min in supine position and 61, 28 and 17min in right position, respectively. Mean RDI at supine position was higher than other positions. Mean minimal oxygen saturation at supine position was significantly lower than other positions. Maximal heart rate and mean arousal index were significantly higher in the supine position. Duration of sleep was highest in the right position in those older than 60 years. Subjects with 40-60 years age had higher duration of sleep in right and supine positions. Female subjects slept more in supine position whereas male ones slept more in right position. Stages of sleep may change according to position. Deteriorations in the parameters of sleep quality (RDI, lowest saturation, arousal index, heart rate) occur in individuals with RDI < 5 as well as in patients with OSA in the supine position

COPD: eine unterdiagnostizierte Erkrankung. Ergebnisse einer Screeningstudie in der Umgebung eines Spitals

Background and Aim Chronic obstructive pulmonary disease (COPD) is a serious disease with morbidity and mortality due to delayed diagnosis until significant symptoms arise. We aimed to assess the utility of spirometry and COPD Assessment Test (CAT) in detecting undiagnosed COPD patients in a localized area