Acromegaly and Obstructive Sleep Apnea: Identifying the High-Risk Group

Objectives: Previous studies have reported increased perioperative complications among obstructive sleep apnea (OSA) patients undergoing transsphenoidal surgery. Although an increased prevalence of OSA in patients with acromegaly has long been recognized, there is paucity of data specifically investigating the impact of OSA on surgical outcomes in this population. The aim of this study was therefore to compare the surgical outcomes of endoscopic transsphenoidal pituitary surgery in acromegalic patients with functional pituitary tumors with and without a diagnosis of OSA.

Methods: A total of 36 patients with acromegaly undergoing endoscopic transsphenoidal pituitary surgery from 2013 to 2017 at a single-tertiary center were retrospectively reviewed. Patients were stratified into two separate groups based on the presence or absence of a diagnosis of OSA.

Results: Out of 36 patients, 18 (50%) patients had a confirmed diagnosis of OSA. The OSA cohort had a higher mean preoperative age at resection (55.33 ± 11.97 vs. 43.78 ± 13.99 years, p < 0.01) as compared with those without an OSA diagnosis. Both groups had comparable smoking history, preoperative cardiac, pulmonary and thromboembolic comorbidities (p > 0.05), as well as preoperative mean BMI (OSA 32.65 ± 7.72 vs. 28.56 ± 5.09 in non-OSA, p = 0.07). The presence of an intraoperative CSF leak was significantly lower in the OSA cohort (17 vs. 61%; OR, 0.127; CI, 0.027–0.606; p = 0.02). Other parameters, including tumor volume, presence of apoplexy, tumor subtype, tumor invasiveness, extent of resection, and type of reconstruction were similar among the groups (p > 0.05). Length of hospital stay, recurrence, 30-day readmission, epistaxis, postoperative CSF leaks and mortality were comparable (p > 0.05).

Conclusion: In acromegalic patients who underwent endoscopic transsphenoidal pituitary surgery, the rate of intraoperative CSF leak was significantly lower in those patients with a diagnosis of OSA. This may be related to improved preoperative management in these patients or an under recognized/under treated OSA in this at-risk population, in general. Further investigation is warranted.

No conflict of interest has been declared by the author(s).