Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
J Clin Endocrinol Metab. 2010 May;95(5):2211-8. doi: 10.1210/jc.2009-2003. Epub 2010 Mar 23.
Retrospective studies suggest that adolescents with craniopharyngioma and hypothalamic obesity have increased sleep-disordered breathing (SDB).
The objectives of this study were to compare the prevalence of SDB in adolescents with craniopharyngioma-related obesity compared with body mass index (BMI)-matched controls and to explore possible relationships between SDB, insulin resistance, and adipocytokines.
This was a cross-sectional study of obese craniopharyngioma and obese control adolescents.
Subjects were evaluated in the clinical investigation unit at the Hospital for Sick Children, Toronto.
Fifteen patients with craniopharyngioma-related obesity and 15 BMI-matched controls were recruited and tested.
Each subject underwent fasting blood work, frequent sampled iv glucose tolerance test, polysomnography, and abdominal magnetic resonance imaging with calculation of visceral and sc adipose tissue.
Main measures included insulin sensitivity, sleep efficiency, and fragmentation.
Insulin sensitivity was lower in craniopharyngioma subjects compared with control subjects (0.96 +/- 0.34 vs. 1.67 +/- 0.7, P = 0.01). Sleep-onset latency (19.3 +/- 27.8 vs. 31.9 +/- 23.4, P = 0.03) and oxygen saturations (rapid eye movement sleep: 89.0 +/- 5.1 vs. 94.2 +/- 2.3, P < 0.001; non-rapid eye movement sleep: 88.4 +/- 5.6 vs. 94.3 +/- 1.5, P < 0.001) were lower in craniopharyngioma. Obstructive apnea-hypopnea index (OAHI) (7.5 +/- 9.0 vs. 1.5 +/- 1.5, P = 0.03) was higher in craniopharyngioma. Respiratory distress index and OAHI correlated negatively with adiponectin concentrations (r = -0.61, P = 0.03, r = -0.71, P = 0.006, respectively) in craniopharyngioma. On multiple regression, TNF-alpha and craniopharyngioma were independent positive predictors of sleep-onset latency and adiponectin and craniopharyngioma were significant predictors (negative and positive, respectively) of OAHI.
SDB is increased in adolescents with craniopharyngioma-related obesity compared with BMI-matched controls. Routine polysomnography should be considered in obese patients with craniopharyngioma and appropriate treatment initiated.
回顾性研究表明，颅咽管瘤伴下丘脑性肥胖的青少年存在睡眠呼吸障碍（SDB）增加的情况。
本研究旨在比较颅咽管瘤相关肥胖青少年与体重指数（BMI）匹配的对照组之间 SDB 的患病率，并探讨 SDB 与胰岛素抵抗和脂肪细胞因子之间的可能关系。
这是一项在多伦多 SickKids 医院临床研究单位进行的肥胖颅咽管瘤和肥胖对照组青少年的横断面研究。
研究对象在多伦多 SickKids 医院的临床研究单位进行评估。
招募并测试了 15 名颅咽管瘤相关肥胖患者和 15 名 BMI 匹配的对照组。
每位受试者均进行空腹血液检查、多次静脉内葡萄糖耐量试验、多导睡眠图和腹部磁共振成像，计算内脏和皮下脂肪组织。
主要观察指标包括胰岛素敏感性、睡眠效率和碎片化。
颅咽管瘤患者的胰岛素敏感性低于对照组（0.96±0.34 对 1.67±0.7，P=0.01）。与对照组相比，颅咽管瘤患者的睡眠潜伏期（19.3±27.8 对 31.9±23.4，P=0.03）和氧饱和度（快速眼动睡眠：89.0±5.1 对 94.2±2.3，P<0.001；非快速眼动睡眠：88.4±5.6 对 94.3±1.5，P<0.001）更低。颅咽管瘤患者的阻塞性呼吸暂停低通气指数（OAHI）更高（7.5±9.0 对 1.5±1.5，P=0.03）。颅咽管瘤患者的呼吸窘迫指数和 OAHI 与脂联素浓度呈负相关（r=-0.61，P=0.03，r=-0.71，P=0.006）。多元回归分析显示，TNF-α和颅咽管瘤是睡眠潜伏期的独立正预测因子，而脂联素和颅咽管瘤是 OAHI 的显著预测因子（分别为负相关和正相关）。
与 BMI 匹配的对照组相比，颅咽管瘤相关肥胖的青少年 SDB 增加。应考虑对肥胖的颅咽管瘤患者进行常规多导睡眠图检查，并启动适当的治疗。
