Elevated incidence of sleep apnoea in acromegaly-correlation to disease activity.

PURPOSE: An elevated prevalence of sleep apnoea (SA) in patients with acromegaly has been suggested. METHODS: We performed polysomnographies in 52 patients with acromegaly (25 m, 27 f, age 51 years, range 19-82 years). Patients were defined having SA if they had more than five apnoeas or hypopnoeas per hour (respiratory disturbance index = RDI). The type of SA was divided into obstructive (OSA), central (CSA) or mixed (OSA+CSA). Seventeen patients had newly diagnosed disease, and 18 patients were treated with somatostatin analogues. RESULTS: Twenty-three patients had controlled disease activity (mean GH levels <1 µg/l during a 3-h profile and normalised IGF-1 levels). Twelve had active acromegaly despite medical treatment. Thirty patients (58%) had SA. Twenty-five of those had OSA, three had CSA, and two had mixed. Of the patients with active disease, 66% had SA, compared to 48% in the cured group. Significantly more patients with hypertension (n = 18) than without hypertension (n = 12, p = 0.041) had SA. Basal glucose was not significantly different between patients with (100 mg/dl, range 75-207 mg/dl) and without SA (92 mg/dl, range 74-120 mg/dl), but HbA1c was significantly higher in patients with SA (5.9% (4.9-9.0%) vs. 5.4% (4.3-6.1%), p = 0.001). A positive correlation between RDI and BMI (p = 0.04), RDI and age (p = 0.013) and RDI and disease activity (p = 0.014) was seen. No major correlation could be found between RDI and the duration of disease activity nor between RDI and GH levels. CONCLUSION: RDI correlates positively with disease activity but not with the duration of the disease. The parameters of the metabolic syndrome are positively associated to the degree of SA in acromegalic patients.

[The Zurich prospective dementia study 1987-1993]. / Die Zürcher Prospektive Demenzstudie 1987-1993.

1987-1993 the Zurich prospective dementia study examined twice yearly 308 nursing-home patients: 192 with senile dementia of Alzheimer-type, 18 with Parkinsonism, 20 with Parkinson dementia and 78 controls, with the Zurich variant of the mini-mental state and rated their dementia state by CDR, activities of daily living with ADL and social behavior with an SVS-scale. At the end of the study or at death the average age was 86.2 years (range 63-103 and 159 autopsies were performed which confirmed the clinical diagnoses at least partly in 70%. Of the 62 cases with autopsies who had been studied more than two years 25 showed M.Alzheimer, 8 M, Parkinson, 7 vascular dementia and 13 a combination of those three diagnoses 40% of these Alzheimer patients exhibited no deterioration in the SVS for two years, 40% respectively 30% during one, resp. two years in the CDR, 20% resp. 40% in the ADL and 23% resp. 5% in the MMS. This demonstrates that good nursing-home care can stabilize behaviour and to a lesser extent even cognitive abilities of a large minority of patients with a pathologically confirmed progressive dementing illness.