High prevalence of severe sleep cycle disruption in de novo acromegaly and underdiagnosis by common clinical screening tools: A prospective, observational, cross-sectional study.

CONTEXT: Although sleep disordered breathing (SDB) is well-recognised in acromegaly, most studies have reported heterogeneous, often heavily treated, groups and few have performed detailed sleep phenotyping at presentation. OBJECTIVE: To study SDB using the gold standard of polysomnography, in the largest group of newly-diagnosed, treatment-naïve patients with acromegaly. SETTING AND PATIENTS: 40 patients [22 males, 18 females; mean age 54 years (range 23-78)], were studied to: (i) establish the prevalence and severity of SDB (ii) assess the reliability of commonly employed screening tools [Epworth Sleepiness Scale (ESS) and overnight oxygen desaturation index (DI)] to detect SDB (iii) determine the extent to which sleep architecture is disrupted. RESULTS: Obstructive sleep apnoea (OSA), defined by the apnoea-hypopnoea index (AHI), was present in 79% of subjects (mild, n = 12; moderate, n = 5; severe, n = 14). However, in these individuals with OSA by AHI criteria, ESS (positive in 35% [n = 11]) and DI (positive in 71%: mild, n = 11; moderate, n = 6; severe, n = 5) markedly underestimated its prevalence/extent. Seventy-eight percent of patients exhibited increased arousal, with marked disruption of the sleep cycle, despite most (82%) having normal total time asleep. Fourteen patients spent longer in stage 1 sleep. Deeper sleep stages were severely attenuated in many subjects (reduced stage 2, n = 18; reduced slow wave sleep, n = 24; reduced rapid eye movement sleep, n = 32). CONCLUSION: Our study provides strong support for clinical guidelines that recommend screening for sleep apnoea syndrome in patients with newly-diagnosed acromegaly. Importantly, however, it highlights shortcomings in commonly recommended screening tools (questionnaires, desaturation index) and demonstrates the added value of polysomnography to allow timely detection of obstructive sleep apnoea and associated sleep cycle disruption.

Gestational diabetes - Major problems with post-partum testing.

BACKGROUND: Post-partum follow up testing of women with gestational diabetes mellitus (GDM) is important. All women, and their family doctors, receive written reminders. There are no recent major Australian reviews of the efficacy and compliance with this advice conducted in an ethnically representative population and using the current diagnostic criteria. AIM: The aim was to examine a cohort of women with recently diagnosed GDM and a completed pregnancy to determine what proportion had been tested and what were the difficulties in having testing carried out. METHODS: Women who were diagnosed with gestational diabetes and attended the Diabetes Service in 2017 were followed up in 2019. Attempted contact was made using an unidentified land line, an identifiable mobile phone and a postal survey. Compliance with testing advice was the major parameter considered. RESULTS: There were 714 women with GDM, 75 were excluded: 64 after pass one and 11 after pass two. In total, only 339/639 (53.1%) could be contacted. Of these women, 334 agreed to be surveyed; 207 (62.0%) had a post-partum test. Of the 127 women who had not had a test, 113 agreed to have an HbA1c. Only 13/113 (11.5%) had this done within a month. CONCLUSION: Contacting women, even within a short time after the pregnancy, is difficult. The number of post-partum tests carried out is suboptimal. Written advice to all women and their doctors does not appear to be working. A review of the cost effectiveness of this approach and development of new methods may be worthwhile.

Twin pregnancy outcomes for women with gestational diabetes mellitus compared with glucose tolerant women.

OBJECTIVE: To examine pregnancy outcomes for women with gestational diabetes mellitus (GDM) and a twin pregnancy compared with glucose tolerant women with a twin pregnancy. DESIGN: Comparison of selected pregnancy outcomes. SETTING: Wollongong, New South Wales, Australia. POPULATION: Women with GDM seen over a 10-year period by an endocrinologist, and women from a selected year of an obstetric database including Wollongong and Shellharbour Hospitals. METHODS: Examination of pregnancy outcome data from the two sources. MAIN OUTCOME MEASURES: Fetal birthweights and method of delivery. RESULTS: There were 28 GDM women with a twin pregnancy from 1229 consecutive referrals (2.3%) of women with GDM for medical management. For comparison there were 29 glucose tolerant women with twin pregnancies evaluable who had delivered over a 1-year period. For the women with GDM and a twin pregnancy there were no significant differences in demographics or outcomes except for a higher rate of elective Caesarean section. CONCLUSION: The higher rate of Caesarean section appeared to be related to the combination of a twin pregnancy and GDM rather than the twin pregnancy or the GDM independently.

Gestational diabetes mellitus: compliance with testing.

An audit of birth records of two public and one private hospital was undertaken, over a 6-month period, to determine compliance with the local policy that all women are tested for gestational diabetes mellitus (GDM). Overall 92.1% of women were tested for GDM. When those women who delivered their babies early or who had no prenatal care were excluded, then there was 95.3% compliance with the advice for universal testing.