Rotating waves during human sleep spindles organize global patterns of activity that repeat precisely through the night | A phase-based analysis reveals wave-like spatiotemporal organization of the human sleep spindle, a brain oscillation critical to sleep-dependent memory consolidation, and elucidates its role in coordinating activity of neural networks distributed across the cortex.
Acromegaly is a rare, chronic and progressive disease characterised by excess secretion of growth hormone with raised insulin-like growth factor I (IGF-I) levels and usually caused by a pituitary adenoma [1, 2]. Its prevalence is estimated at 40–480 cases per million, depending on the study [1, 3]. The diagnosis of acromegaly, frequently made late because of the insidious nature of the disease, is generally based on symptoms of excess growth hormone, such as acral enlargement, soft-tissue swelling, arthralgia, jaw prognathism, hyperhidrosis, osteoarthritis and frontal bossing, or symptoms of a pituitary adenoma, such as headaches, visual defects or pituitary insufficiency. Owing to prolonged untreated progression of the condition, patients often exhibit established systemic complications at diagnosis, such as diabetes mellitus (19–56%) , hypertension (30–40%) and respiratory/cardiac failure (60%) [4, 5], which are the main determinants of prognosis and premature mortality . The majority of new diagnoses of acromegaly are detected by primary care physicians, or specialists other than endocrinologists. The therapeutic options for acromegaly include endoscopic surgery, medical therapies (long-acting somatostatin analogues; dopamine agonists; growth hormone receptor antagonists) and pituitary radiotherapy [6, 7]. 45–80% of acromegaly patients have sleep apnoea syndrome (SAS) [4, 5], compared to 5% in the general population. Because of swelling of the uvula, macroglossia and maxillofacial modifications, obstructive sleep apnoea (OSA) is the prevailing form of SAS . The combination of OSA and acromegaly increases the risk of systemic comorbidities and mortality . The high prevalence of acromegaly-related comorbidities and its often late diagnosis , when valid treatment options exist, make screening for acromegaly in at-risk populations necessary. The OSA population might constitute a target group for the earlier detection of acromegaly, thereby preventing the late complications of the disease. Moreover, early treatment of acromegaly may favour the resolution of associated SAS. We prospectively assessed the prevalence of undiagnosed acromegaly in new patients suspected of suffering from OSA.
Among patients with confirmed obstructive sleep apnoea the prevalence of acromegaly was 0.35%
We thank Alison Foote (Grenoble Alpes University Hospital, Grenoble, France) for rewriting the manuscript.
Authors’ contributions: J-L. Pépin had full access to all of the data in the study, takes responsibility for the content of the manuscript, including the data and analysis, and contributed to the study hypothesis, study design, data collection and analyses, writing the manuscript and sharing scientific discussions. L-M. Galerneau contributed to the study design, data collection and analyses, writing the manuscript and sharing scientific discussions. A-L. Borel contributed to the study design, analyses and revising the manuscript. O. Chabre contributed to the study hypothesis, study design, data collection and analyses, revising the manuscript and sharing scientific discussions. M. Sapene, B. Stach and J. Girey-Rannaud contributed to the study hypothesis, study design and data collection. R. Tamisier and P. Caron contributed to the study hypothesis, study design, data collection and analyses, writing the manuscript and sharing scientific discussions. N. Arnol performed the statistical analyses and contributed to revising the manuscript.
Prior abstract publication/presentation: French National Sleep Congress, Nantes, November 2015; American Thoracic Society Conference, San Francisco, May 2016.
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