Dr. Rick Balys, MD, FRCSC
Otolaryngology / Head and Neck Surgery
“But doc…I never used to snore. I slept well. About 4 months ago I started to snore. Now I am so loud I keep the whole house up and feel exhausted in the morning and throughout the day. I have only gained about 5 pounds – do you think that caused this?” As a physician, this history should raise warning flags.
Although this is rare, I see a few patients every year with a history similar to this which requires a search for a cause of the sleep apnea.
Sleep Apnea is typically a slowly progressive disease that starts as snoring. Fatigue and poor sleep quality associated with snoring is a sign of Upper Airway Resistance Syndrome which can be thought of as a step before the development of airway obstruction and sleep apnea. This process typically takes years and is usually associated with increasing weight and a sedentary lifestyle. In some cases however things seem to develop much faster. As a surgeon operating on patients with obstructive sleep apnea, I am always on the watch for these patients where sleep apnea may be a sign of another disease. Acromegaly is one of these diseases.
Acromegaly is abnormal production of growth hormone, usually by a benign tumor of the pituitary gland. It is not a common disease and there is often a delay in the diagnosis leading to some irreversible secondary changes. Growth hormone in an adult leads to progressive enlargement of the hands, feet, tongue, nose, lips, ears, forehead, and jaw. The voice becomes deep and there is often increased sweating. Treatment can improve some of these changes but most changes are irreversible so we would like to catch this disease at its earliest possible stage.
Why do Patients with Acromegaly get Obstructive Sleep Apnea?
The incidence of sleep apnea in a patient with Acromegaly is over 80% so sleep apnea can be one of the first signs allowing early diagnosis. This is due predominantly to an increased size of the tongue which pushes into the airway, enlargement of the tonsils and uvula, and a more collapsible airway. This results in snoring and sleep apnea. Acromegaly and sleep apnea are both associated with heart disease and high blood pressure so early diagnosis and treatment of both are essential to avoid long term problems.
When first diagnosed, patients will typically be placed on a medication which stops the production of growth hormone. Studies show early medical treatment can improve and possibly resolve obstructive sleep apnea. CPAP (Continuous Positive Airway Pressure) will use air under pressure to keep the tongue and side walls of the throat out of the airway during sleep. Most people with Acromegaly and Obstructive Sleep Apnea will have great benefit in their symptoms and reduced long term risks associated with both diseases.
If you feel that your snoring and sleep apnea came on quickly without an explanation, ask about Acromegaly and other medical diseases that can cause sleep apnea. You can get more information about Acromegaly and support in Nova Scotia.