Polysomnographic findings in five adult patients with pituitary insufficiency before and after cessation of human growth hormone replacement therapy
Polysomnographic findings in five adult patients with pituitary insufficiency before and after cessation of human growth hormone replacement therapy
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DOI：
10.1046/j.1365-2265.2002.01531.x
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发表时间：
2002-06-01
影响因子：
3.2
通讯作者：
Hüfner, M
中科院分区：
文献类型：
--
作者：
Nolte, W;Rädisch, C;Hüfner, M
目的 我们观察了一名成年男性患者在人类生长激素 (hGH) 替代治疗期间新发的严重阻塞性睡眠呼吸暂停综合征 (OSAS)。这促使我们评估 hGH 替代疗法对中年男性睡眠的潜在影响。设计一项纵向研究。受试者 5 名术后垂体功能不全的男性患者（年龄 44-56 岁，中位年龄 54 岁）接受 hGH 替代疗法 12 年（中位剂量 2.0 U/天；中位 IGF-I 血清浓度 351 微克/升）和停止 hGH 治疗 6 个月后（中位剂量IGF-I 水平 77 微克/升 - 1 微克/升 = 0.131 纳摩尔/升）。 测量 进行多导睡眠图研究，并确定以下参数：卧床时间 (TIB)、睡眠周期时间 (SPT)、总睡眠时间 (TST)、睡眠效率 (SE = TST/TIB)、睡眠阶段 I 起始潜伏期 (SL)、不同睡眠阶段 [W（清醒）、S1、S2、SWS（慢速）波浪睡眠 = S3 + S4) 和 REM； SPT 的百分比]、SPT 每小时的阶段转移 (SS[h)、SPT 的 W/h 阶段转移 [A/h（觉醒）]、TST 每小时的呼吸暂停和低通气事件指数 (AH/h)、TST 每小时的呼吸暂停和低通气唤醒次数 (Ar/h)、阻塞性指数 (OAH/h)、中枢性事件 (CAH/h) 和混合事件 (MAH/h)每小时 TST 和最小去饱和 (MD) 的呼吸暂停和低通气次数。 结果 中位基线结果为：TIB，479 分钟；TIB，479 分钟； SPT，465 分钟；尖沙咀，405 分钟；东南欧，77%； SL，8.5 分钟；女，18.9%； S1，8.2%； S2，52.7%；快速眼动，13.5%； SS/小时，17.7；安/小时，2.8；安时/小时，11.9；氩气/小时，4.4；医学博士，80%。 hGH 治疗停止后，这些参数没有显着变化。相比之下，中位 SWS 从 33 分钟 (7.1%) 显着下降至 7.5 分钟 (1.8%；P=0.03)。停止 hGH 后，中位 OAH/h 从 4.4 显着下降至 0.1（P = 0.03），而 CAH/h 从 6.3 增加至 14.6（P = 0.03）。相应地，一名 OSAS 患者明显改善，而另一名患者在停止 hGH 后出现新的无症状中枢 SAS。 结论 这项研究表明，hGH 替代疗法以复杂的方式影响中年男性的睡眠反应。停止治疗与慢波睡眠显着减少以及从阻塞性呼吸暂停和低通气转变为中枢性呼吸暂停有关。
OBJECTIVE We observed the new onset of severe obstructive sleep apnoea syndrome (OSAS) in an adult male patient during human growth hormone (hGH) replacement therapy. This prompted us to evaluate the potential influence of hGH substitution therapy on sleep in middle-aged men.DESIGN A longitudinal study.SUBJECTS Five male patients (aged 44-56 years, median age 54 years) with postoperative pituitary insufficiency given hGH replacement therapy for 12 years (median dose 2.0 U/day; median IGF-I serum concentration 351 mug/l) and 6 months after cessation of hGH treatment (median IGF-I level 77 mug/l - 1 mug/l = 0.131 nmol/l).MEASUREMENTS Polysomnographic studies were performed, and the following parameters were determined: time in bed (TIB), sleep period time (SPT), total sleep time (TST), sleep efficiency (SE = TST/TIB), sleep stage I onset latency (SL), different sleep stages [W (wake), S1, S2, SWS (slow wave sleep = S3 + S4) and REM; % of SPT], stage shifts per hour of SPT (SS[h), stage shifts to W/h of SPT [A/h (awakening)], index of apnoea and hypopnoea events per hour of TST (AH/h), arousals from apnoea and hypopnoea per hour of TST (Ar/h), index of obstructive (OAH/h), central (CAH/h) and mixed (MAH/h) events of apnoea and hypopnoea per hour of TST and minimal desaturation (MD).RESULTS Median baseline results were: TIB, 479 min; SPT, 465 min; TST, 405 min; SE, 77%; SL, 8.5 min; W, 18.9%; S1, 8.2%; S2, 52.7%; REM, 13.5%; SS/h, 17.7; A/h, 2.8; AH/h, 11.9; Ar/h, 4.4; MD, 80%. These parameters did not change significantly after cessation of hGH treatment. In contrast, median SWS decreased significantly from 33 min (7.1%) to 7.5 min (1.8%; P= 0.03). Median OAH/h decreased significantly from 4.4 to 0.1 (P = 0.03) whereas CAH/h increased from 6.3 to 14.6 (P = 0.03) after cessation of hGH. Correspondingly, one patient with OSAS improved markedly whereas another patient developed new and asymptomatic central SAS after cessation of hGH.CONCLUSION This study showed that hGH replacement therapy influenced sleep reaction in a complex way in middle-aged men; cessation of treatment was associated with a significant decrease in slow wave sleep and a shift from obstructive to central apnoea and hypopnoea.