Abstract
Craniopharyngiomas are slow growing tumors of the sellar and parasellar region and may also involve the hypothalamus. Treatment involves maximal surgical excision or subtotal resection followed by focal radiation therapy. Late effects of treatment include endocrinopathies, cognitive deficits, behavioral changes, obesity and sleep dysfunction. We conducted a retrospective review of all patients with craniopharyngioma more than 2 years off treatment and who were evaluated in the neuro-oncology survivorship clinic between 2003 and 2007. Clinical data, extent of resection, treatment modalities, endocrine status, patient symptom report and sleep study results were collected to evaluate the presence of patient reported daytime sleepiness and sleep disturbance and to determine possible risk factors. 28 patients were identified (25 %) female. 19/28 self-reported daytime fatigue or sleep disturbance; this included 4/6 patients with gross total resection and 15/22 with subtotal resection. 16/22 patients treated with cranial irradiation reported sleep-related abnormalities, compared to 3/6 patients who did not receive radiation. All but one patient had pituitary dysfunction requiring hormonal replacement. Patients with more than ≥2 sleep related complaints had a higher BMI (44.6 vs. 32.6, p = 0.0192). 8 patients underwent formal sleep evaluation. 3 patients had documented central or obstructive sleep apnea. The mean arousal index was 11.0/h (normal <5). Two patients were treated with melatonin for sleep disturbance and 2 were treated with stimulants for excessive daytime sleepiness. A majority of patients with craniopharyngioma have self-reported daytime fatigue and/or sleep dysfunction after treatment. Extent of resection did not increase the likelihood of patient-reported daytime sleepiness and/sleep dysfunction; however, patients who received radiation more frequently reported daytime sleepiness and/or sleep dysfunction. Patients with a higher BMI were more likely to experience sleep disturbance. Formal sleep evaluations should be considered in all patients with craniopharyngioma.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Prabhu VC, Brown HG (2005) The pathogenesis of craniopharyngiomas. Childs Nerv Syst 21:622–627
Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM (1998) The descriptive epidemiology of craniopharyngioma. J Neurosurg 89:547–551
Muller HL (2008) Childhood craniopharyngioma-recent advances in diagnosis, treatment and follow-up. Horm Res 69:193–202
Winkfield KM, Tsai HK, Yao X, Larson E, Neuberg D, Pomeroy SL, Ullrich NJ, Cohen LE, Kieran MW, Scott RM, Goumnerova LC, Marcus KJ (2011) Long-term clinical outcomes following treatment of childhood craniopharyngioma. Pediatr Blood Cancer 56:1120–1126
Waber DP, Pomeroy SL, Chiverton AM, Kieran MW, Scott RM, Goumnerova LC, Rivkin MJ (2006) Everyday cognitive function after craniopharyngioma in childhood. Pediatr Neurol 34:13–19
Sands SA, Milner JS, Goldberg J, Mukhi V, Moliterno JA, Maxfield C, Wisoff JH (2005) Quality of life and behavioral follow-up study of pediatric survivors of craniopharyngioma. J Neurosurg 103(4 suppl):302–311
Muller HL, Bruhnken G, Emser A, Faldum Etavard-GorrisN, Gebhardt U, Kolb R, Sorensen N (2005) Longitudinal study on quality of life in 102 survivors of childhood craniopharyngioma. Childs Nerv Syst 21:975–980
Poretti A, Grotzer MA, Ribi K, Schonle E, Bolthauser E (2004) Outcome of craniopharyngioma in children: long-tem complications and quality of life. Dev Med Child Neurol 46:220–229
Van der Klaauw AA, Biermasz NR, Pereira AM, van Kralingen KW, Dekkers OM, Rabe KF, Smit JW, Romijn JA (2008) Patients cured from craniopharyngioma or nonfunctioning pituitary macroadenoma (NFMA) suffer similarly from increased daytime somnolence despite normal sleep patterns compared to healthy controls. Clin Endocrinol 69:769–774
Lipton J, Megerian JT, Kothare SV, Cho YJ, Shanahan T, Chart H, Ferber R, Adler-Golden L, Cohen LE, Czeisler CA, Pomeroy SL (2009) Melatonin deficiency and disrupted circadian rhythms in pediatric survivors of craniopharyngioma. Neurology 73:323–325
Muller HL, Handwerker G, Wollny B, Faldum A, Sorensen N (2002) Melatonin secretion and increased daytime sleepiness in childhood craniopharyngioma patients. J Clin Endocrinol Metab 87:3993–3996
Muller HL, Handwerker G, Gebhardt U (2006) Melatonin treatment in obese patients with childhood craniopharyngioma and increased daytime sleepiness. Cancer Causes Control 17:583–589
Snow A, Gozal E, Malhotra A, Tiosano D, Perlman R, Vega C, Shahar E, Gozal D, Hochberg Z, Pillar G (2002) Severe hypersomnolence after pituitary/hypothalamic surgery in adolescents: clinical characteristics and potential mechanisms. Pediatrics 110:e74–e80
Flint J, Kothare SV, Zihlif M, Suarez E, Adams R, Legido A, De Luca F (2007) Association between inadequate sleep and insulin resistance in obese children. J Pediatr 150:364–369
Mulrooney DA, Ness KK, Neglia JP, Whitton JA, Green DM, Zeltzer LK, Robison LL, Mertens AC (2008) Fatigue and sleep disturbance in adult survivors of childhood cancer: a report for the childhood cancer survivor study (CCSS). Sleep 31:271–281
Saper CB, Scammell TE, Lu J (2005) Hypothalamic regulation fo sleep and circadian rhythms. Nature 437:1257–1263
Scheer F, Czeisler CA (2005) Melatonin, sleep, and circadian rhythms. Sleep Med Rev 9:5–9
Rosen GM, Bendel AE, Neglia JP, Moertel CL, Mahowald M (2003) Sleep in children with neoplasms of the central nervous system: case review of 14 children. Pediatrics 112:e46–e54
Conflict of interest
All authors declare that they have no conflict of interest
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Manley, P.E., McKendrick, K., McGillicudy, M. et al. Sleep dysfunction in long term survivors of craniopharyngioma. J Neurooncol 108, 543–549 (2012). https://doi.org/10.1007/s11060-012-0859-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-012-0859-7