Müller Hermann L, Müller-Stöver Sarah, Gebhardt Ursel, Kolb Reinhard, Sörensen Niels, Handwerker Georg
Department of Pediatrics, Klinikum Oldenburg, Oldenburg, Germany.
J Pediatr Endocrinol Metab. 2006 Apr;19 Suppl 1:423-9. doi: 10.1055/s-2006-974095.
Prognosis in childhood craniopharyngioma survivors hinges upon late effects such as pituitary deficiency and obesity. Observations indicate that reduced physical activity and increased daytime sleepiness might be risk factors for obesity. We analyzed the degree of daytime sleepiness in 115 childhood craniopharyngioma patients (47% obese) using the Epworth Sleepiness Scale (ESS). Thirty-five (30%) displayed increased daytime sleepiness (ESS score > 10) of whom 14 were obese (26% of obese cohort). Polysomnography (PSG) and Multiple Sleep Latency Tests (MSLT) were conducted with 10 obese patients presenting increased daytime sleepiness, with only two craniopharyngioma patients revealing a sleep related breathing disorder. Four patients had repeated episodes of SOREM (sleep onset rapid eye movement), the classic PSG criterion for narcolepsy. Three patients displayed hypersomnia. All but one patient qualified as acutely obese. We speculate that secondary narcolepsy is an exacerbating condition of childhood craniopharyngioma obesity, supported by recent reports on orexin and narcolepsy which suggest hypothalamic failure in idiopathic narcolepsy.
儿童颅咽管瘤幸存者的预后取决于垂体功能减退和肥胖等晚期效应。观察表明，身体活动减少和日间嗜睡增加可能是肥胖的危险因素。我们使用爱泼华嗜睡量表（ESS）分析了115例儿童颅咽管瘤患者（47%为肥胖患者）的日间嗜睡程度。35例（30%）患者表现出日间嗜睡增加（ESS评分>10），其中14例为肥胖患者（占肥胖队列的26%）。对10例表现出日间嗜睡增加的肥胖患者进行了多导睡眠图（PSG）和多次睡眠潜伏期测试（MSLT），只有2例颅咽管瘤患者显示出与睡眠相关的呼吸障碍。4例患者出现多次睡眠始发快速眼动（SOREM）发作，这是发作性睡病的经典PSG标准。3例患者表现为嗜睡症。除1例患者外，所有患者均符合急性肥胖标准。我们推测继发性发作性睡病是儿童颅咽管瘤肥胖的一种加重情况，最近关于食欲素和发作性睡病的报道支持了这一推测，这些报道表明特发性发作性睡病存在下丘脑功能障碍。
