Effects of pegvisomant on sleep apnoea and tongue volume (MRI) in patients with acromegaly

Sleep apnoea has been consistently reported to occur in acromegaly. In poorly controlled patients, the severity of sleep apnoea may influence physical activity in the daytime. To address this issue, we investigated the influence of disease activity on tongue volume and sleep apnoea treated with the GH-receptor antagonist pegvisomant in poorly controlled patients with acromegaly under octreotide. 14 patients with active acromegaly (9 females; 5 males; mean age 55±14yrs; BMI 28.0±4.9kg/m²; mean±SD) were treated with pegvisomant (13.5±5.0mg/die) over 6 months. Tongue volume was examined by magnet resonance imaging and sleep apnoea was characterized by polysomnography before and after 6 months treatment with pegvisomant. The initial tongue volume was significantly higher in patients with acromegaly (142±48ml) in comparison to the BMI and age-matched healthy control group (97±5ml, p=0.02). Results of 7/14 were present. IGF-1 levels reduced after 6 months (361±161 to 212±71µg/L; p=0.04). The tongue volume decreased significantly (142±48 to 105±25ml; p=0.017) whereas the apnoea-hypnoea-index (AHI) only decreased as a tendency (26±26 to 22±26 /h; p=0.14). In conclusion, successful treatment with pegvisomant can decrease tongue volume, which may have benefits for coexisting sleep disordered breathing.