Temporal relationship of sleep apnea and acromegaly: a nationwide study
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ORIGINAL ARTICLE
Temporal relationship of sleep apnea and acromegaly: a nationwide study Konstantina Vouzouneraki 1 Karl A. Franklin2 Maria Forsgren3 Maria Wärn4 Jenny Tiberg Persson5 Helena Wik5 Christina Dahlgren6 Ann-Sofie Nilsson7 Caroline Alkebro8 Pia Burman7 Eva-Marie Erfurth7 Jeanette Wahlberg6 Anna-Karin Åkerman8 Charlotte Høybye4 Oskar Ragnarsson5 Britt Edén Engström3 Per Dahlqvist1 ●
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Received: 17 April 2018 / Accepted: 23 July 2018 © The Author(s) 2018
Abstract Purpose Patients with acromegaly have an increased risk of sleep apnea, but reported prevalence rates vary largely. Here we aimed to evaluate the sleep apnea prevalence in a large national cohort of patients with acromegaly, to examine possible risk factors, and to assess the proportion of patients diagnosed with sleep apnea prior to acromegaly diagnosis. Methods Cross-sectional multicenter study of 259 Swedish patients with acromegaly. At patients’ follow-up visits at the endocrine outpatient clinics of all seven university hospitals in Sweden, questionnaires were completed to assess previous sleep apnea diagnosis and treatment, cardiovascular diseases, smoking habits, anthropometric data, and S-IGF-1 levels. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale. Patients suspected to have undiagnosed sleep apnea were referred for sleep apnea investigations. Results Of the 259 participants, 75 (29%) were diagnosed with sleep apnea before the study start. In 43 (57%) of these patients, sleep apnea had been diagnosed before the diagnosis of acromegaly. After clinical assessment and sleep studies, sleep apnea was diagnosed in an additional 20 patients, yielding a total sleep apnea prevalence of 37%. Higher sleep apnea risk was associated with higher BMI, waist circumference, and index finger circumference. Sleep apnea was more frequent among patients with S-IGF-1 levels in the highest quartile. Conclusion Sleep apnea is common among patients with acromegaly, and is often diagnosed prior to their acromegaly diagnosis. These results support early screening for sleep apnea in patients with acromegaly and awareness for acromegaly in patients with sleep apnea. Keywords Acromegaly Sleep apnea Comorbidities Risk factors ●
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Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12020-018-1694-1) contains supplementary material, which is available to authorized users. * Konstantina Vouzouneraki [email protected] 1
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala, Sweden
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Department of Molecular Medicine and Surgery, Patient Area Endocrinology and Nephrology, Inflammation and Infection Theme, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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Department of Endocri
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