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Sindrome delle apnee notturne nelle malattie endocrino-metaboliche

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L’Endocrinologo Aims and scope

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La sindrome delle apnee ostruttive durante il sonno (OSAS) è caratterizzata da ripetuti episodi di ostruzione completa o parziale delle vie aeree superiori che si verificano durante il sonno e durano oltre 10 secondi. Le apnee inducono una riduzione della saturazione in ossigeno dell’emoglobina e brevissimi risvegli, responsabili di una marcata frammentazione del sonno notturno, tale che i pazienti lamentano russamento notturno, un’eccessiva sonnolenza diurna ed una compromissione delle performance quotidiane. L’OSAS è clinicamente importante perché si associa ad un maggiore rischio di sviluppare malattie cardiovascolari e diabete mellito e ad un’elevata mortalità sia per tali patologie sia per un aumentato rischio di incidenti stradali e sul lavoro. La diagnosi di certezza si formula mediante polisonnografia durante il sonno. La terapia con ventilazione continua a pressione positiva (CPAP) è attualmente la più efficace e va integrata con modificazioni dello stile di vita e, in casi selezionati, con la terapia chirurgica. L’obesità, in particolare l’accumulo di grasso in sede centrale, è un importante fattore di rischio per l’OSAS, la cui prevalenza mostra una stretta correlazione con il grado di adiposità, che è di circa il 40% nei pazienti con obesità di 3° grado. Accanto all’obesità, anche il diabete mellito ed alcune patologie endocrinologiche (gozzo tiroideo, ipotiroidismo, acromegalia, sindrome dell’ovaio policistico) si associano con l’OSAS con una frequenza maggiore che nella popolazione generale, potendo rappresentare un fattore di rischio per i disturbi respiratori durante il sonno. D’altra parte, l’OSAS è a sua volta responsabile di alcune alterazioni metaboliche ed ormonali quali l’insulino-resistenza, il diabete mellito, l’iperattività simpato-adrenergica, la maggiore produzione di cortisolo e l’ipogonadismo parziale nel maschio. In particolare, l’insulino-resistenza e il diabete mellito sono favoriti indipendentemente dall’ipossia, dal russamento e dalla mancanza di sonno.

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Authors and Affiliations

  1. Dipartimento dell’Emergenza e dei Trapianti di Organi (D.E.T.O.), Sezione di Medicina Interna, Endocrinologia e Malattie Metaboliche, Università di Bari, Policlinico di Bari, Piazza Giulio Cesare, 70124, Bari, Italia

    Giovanni De Pergola

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Correspondence to Giovanni De Pergola.

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De Pergola, G. Sindrome delle apnee notturne nelle malattie endocrino-metaboliche. L’Endocrinologo 7, 178–186 (2006). https://doi.org/10.1007/BF03345952

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