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The impact of sleep apnea treatment on carbohydrate metabolism in patients with acromegaly

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Abstract

Sleep Apnea is highly prevalent and may contribute to insulin resistance in patients with acromegaly. The primary aim of this study was to assess the impact of sleep apnea treatment with a continuous positive air pressure (CPAP) device on insulin resistance evaluated by hyperinsulinemic euglycemic clamp (HEC). A prospective, randomized, open label, placebo-controlled, crossover study was performed at a tertiary outpatient pituitary center. Twelve acromegalic subjects on somatostatin analogs (SA) with a recent diagnosis of moderate to severe sleep apnea were randomized to CPAP therapy or to nasal dilator adhesive (NDA) with placebo effect for 3 months and then crossed over for another 3 months period without washout. Assessment of HEC, mathematical insulin resistance indexes (HOMA, HOMA2 and QUICKI), GH, IGF-1, HbA1c and free fat acids were performed. A significant reduction on insulin resistance was demonstrated by HEC at the end of the study in patients on CPAP (HEC, pre- and post-CPAP: 4.27 vs. 6.10 mg/Kg/min, P = 0.032). This reduction was not observed in NDA group (HEC, pre- and post-adhesive: 5.53 vs. 5.19 mg/Kg/min, P = 0.455). There was no significant difference on HbA1c or on peripheral insulin resistance indexes in both treatments. CPAP promoted a significant increase on peripheral insulin sensitivity in acromegalic patients with moderate to severe sleep apnea on SA use. Our results support the concept that sleep apnea plays an important role on glucose metabolism. Insulin resistance indexes were unable to detect this finding.

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Acknowledgments

We thank Dr. Ana Tereza Santomauro for her expertise and intellectual contributions in the clamp procedure. We thank the staff of the hormonal test room and the sleep laboratory for the help in the execution of the clamps and the polysomnographies. We thank Valéria Sutti Nunnes for performing the FFA assays, and we also thank the patients for participating in this demanding study. This research was supported by Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (protocol number: 2008/10045-3).

Ethical standards

The local ethics committee approved the protocol and all participants gave written, informed consent.

Conflict of interest

Authors declare to have no conflict of interests.

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Authors and Affiliations

  1. Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho, 255, 7ºandar, sala 7037, Instituto Central, Cerqueira Cesar, São Paulo, CEP 05403-000, Brazil

    Felipe Henning Gaia Duarte, Raquel Soares Jallad & Marcello Delano Bronstein

  2. Sleep Laboratory, Division of Pneumology, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil

    Aline Cecília Soares Amaro, Luciano Ferreira Drager & Geraldo Lorenzi-Filho

  3. Hypertension Unit, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil

    Luciano Ferreira Drager

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  1. Felipe Henning Gaia Duarte
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  2. Raquel Soares Jallad
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  3. Aline Cecília Soares Amaro
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  5. Geraldo Lorenzi-Filho
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  6. Marcello Delano Bronstein
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Correspondence to Marcello Delano Bronstein.

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Duarte, F.H.G., Jallad, R.S., Amaro, A.C.S. et al. The impact of sleep apnea treatment on carbohydrate metabolism in patients with acromegaly. Pituitary 16, 341–350 (2013). https://doi.org/10.1007/s11102-012-0430-8

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