Oliveira Francielle T, Salvatori Roberto, Marcondes José, Macena Larissa B, Oliveira-Santos Alecia A, Faro Augusto C N, Campos Viviane C, Oliveira Carla R P, Costa Ursula M M, Aguiar-Oliveira Manuel H
Federal University of SergipeDivision of Endocrinology, Aracaju, Brazil.
Division of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine (R.S.) Baltimore, Maryland, USA.
Eur J Endocrinol. 2017 Jul;177(1):51-57. doi: 10.1530/EJE-17-0145. Epub 2017 Apr 21.
GH-releasing hormone (GHRH) exerts hypnotic actions increasing the non-rapid eye movement (NREM) sleep. Conversely, GH stimulates the REM sleep. GH deficiency (GHD) often leads to sleep problems, daytime fatigue and reduced quality of life (QoL). GHD may be due to lack of hypothalamic GHRH or destruction of somatotroph cells. We have described a cohort with isolated GHD (IGHD) due to GHRH resistance caused by a homozygous mutation (c.57 + 1G > A) in the GHRH receptor gene. They have normal QoL and no obvious complaints of chronic tiredness. The aim of this study was to determine the sleep quality in these subjects.
A cross-sectional study was carried out in 21 adult IGHD subjects, and 21 age- and gender-matched controls. Objective sleep assessment included polygraphic records of the awake, stages NREM [N1 (drowsiness), N2 and N3 (already sleeping)] and REM (R). Subjective evaluation included the Pittsburgh Sleep Quality Index, the Insomnia Severity Index and the Epworth Sleepiness Scale.
IGHD subjects showed a reduction in sleep efficiency ( = 0.007), total sleep time ( = 0.028), duration of N2 and R in minutes ( = 0.026 and 0.046 respectively), but had increased duration and percentage of N1 stage ( = 0.029 and 0.022 respectively), wake ( = 0.007) and wake-time after sleep onset ( = 0.017). There was no difference in N3 or in sleep quality questionnaire scores.
Patients with IGHD due to GHRH resistance exhibit objective reduction in the sleep quality, with changes in NREM and REM sleep, with no detectable subjective consequences. GHRH resistance seems to have a preponderant role over GHD in the sleep quality of these subjects.
生长激素释放激素（GHRH）具有催眠作用，可增加非快速眼动（NREM）睡眠。相反，生长激素刺激快速眼动睡眠。生长激素缺乏症（GHD）常导致睡眠问题、日间疲劳和生活质量（QoL）下降。GHD可能是由于下丘脑GHRH缺乏或生长激素细胞破坏所致。我们描述了一个因GHRH受体基因纯合突变（c.57+1G>A）导致GHRH抵抗而出现孤立性GHD（IGHD）的队列。他们的生活质量正常，没有明显的慢性疲劳主诉。本研究的目的是确定这些受试者的睡眠质量。
对21名成年IGHD受试者和21名年龄及性别匹配的对照者进行了横断面研究。客观睡眠评估包括对清醒、NREM阶段[N1（嗜睡）、N2和N3（已入睡）]和快速眼动（R）阶段的多导睡眠图记录。主观评估包括匹兹堡睡眠质量指数、失眠严重程度指数和爱泼华嗜睡量表。
IGHD受试者的睡眠效率降低（=0.007）、总睡眠时间降低（=0.028）、N2和R阶段的时长（分钟）降低（分别为=0.026和0.046），但N1阶段的时长和百分比增加（分别为=0.029和0.022）、觉醒时间增加（=0.007）以及睡眠开始后的觉醒时间增加（=0.017）。N3阶段或睡眠质量问卷评分没有差异。
因GHRH抵抗导致IGHD的患者睡眠质量客观下降，NREM和快速眼动睡眠均有变化，但未发现主观影响。在这些受试者的睡眠质量方面，GHRH抵抗似乎比GHD起更主要的作用。
