We recruited 6 patients with SDB and pituitary adenoma, admitted in our hospital from 2008 to 2011yrs. Physical and anthropometric examinations were performed. BMI was calculated as weight (kilograms)/height2 (square meters). Epworth Sleepiness Scale (ESS) and Berlin questionnaire modified, has been used to diagnose daytime sleepiness and sleep disorders symptoms.
All patients were studied with pulmonary function tests including arterial blood gas analysis, spirometry, Body Plethysmography and 6-minute walk test. (see Table 1)
SDB were studied by means of overnight polysomnographic study in our sleep lab (Weinmann's sleep lab system SOMNOlab). Each subject had overnight polysomnography (PSG) for evaluation of sleep abnormalities, supervised by trained sleep technologists in the sleep medicine laboratory. Every PSG was performed in a quiet, darkened room, without the use of sleep-inducing medications, and was interpreted by a single sleep medicine physician.
The scoring criteria were according to event definition by American Academy of Sleep Medicine (AASM) manual (15). A standard overnight PSG included a 4-lead electroencephalogram (C3, C4, O1, and O2), two bilateral electrooculogram leads referenced to A1 or A2, and one submental and two tibial electromyograms. Respiratory measurements included chest wall and abdominal movement using inductance pneumography; airflow using a nasal cannula connected to a nasal pressure airflow; oxygen saturation (SaO2). Video and audio recordings were obtained for each study. Sleep architecture was assessed by standard techniques (25). Information obtained from each PSG included sleep onset latency (SOL) and rapid eye movement sleep (REM)-onset latency, TST, sleep efficiency, time spent in each sleep stage (minutes and percentage), and the number of arousals. Recorded respiratory data included counts and indices of the following events: obstructive apneas and hypopneas (OAHI), central apneas [central apnea index (CAI)], and mixed apneas recorded in non-REM (NREM) sleep, REM sleep, and total sleep.
Every patient was analyzed in Department of Internal Medicine section of endocrinology. All patients performed a magnetic resonance imaging (MRI). Blood samples were obtained for serum IGF-I, fT3, fT4, TSH, LH, FSH, testosterone (estradiol in fertile females during follicular phase), PRL, ACTH and cortisol. In each patient we performed a basal study of thyroid, adrenal and gonadal - pituitary axis and a dynamic evaluation. Deficit of GH (GHD) were diagnosed with GH-releasing hormone (GHRH) plus arginine stimulation test. Cushing syndrome (CS) was diagnosed with measurement of urinary cortisolo in a low-dose dexamethasone (1 mg) suppression test (Nugent Test), IGF-1 and growth hormone levels and measurement of GH during OGTT (oral glucose tolerance test). All patients except one (not operated for medical reasons) underwent standard 3D endoscopic endonasal trans-sphenoidal surgery in our Neurosurgical Department. Before surgery, they had a complete clinical, endocrinological, and visual field evaluation. The preoperative imaging studies were performed using an MRI with and without intravenous gadolinium contrast and CT scan of the sellar region. All patients had complete removal of the lesions assessed by a postoperative MRI.