Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
Department of Psychology, The University of Memphis, Memphis, TN, USA.
Dev Med Child Neurol. 2021 Aug;63(8):984-990. doi: 10.1111/dmcn.14866. Epub 2021 Mar 22.
To examine the impact of clinical factors, cognitive deficits, and sleepiness on health-related quality of life (HRQoL) among young people with craniopharyngioma.
Seventy-eight patients (67% White; 41 males, 37 females; mean age 10y 8mo, SD 3y 11mo, range 6-20y) with craniopharyngioma were assessed for tumor extent and diabetes insipidus. All patients underwent overnight polysomnography and multiple sleep latency tests after surgical resection. Executive functioning was assessed using parent-reported measures. Patients and their parents completed measures of HRQoL. None had a history of previous radiation therapy.
Path analysis was used to test hypothesized relations while controlling for demographic and disease characteristics. Analyses revealed poorer parent-reported HRQoL among young people with greater executive functioning symptoms (estimate -0.83; p<0.001). Direct and indirect effects were found among diabetes insipidus, executive functioning, and parent-reported HRQoL. Diabetes insipidus directly predicted greater global executive functioning impairment (estimate 5.15; p=0.04) and indirectly predicted lower HRQoL through executive functioning impairment (estimate -4.25; p=0.049). No significant effects were found between excessive daytime sleepiness, tumor hypothalamic involvement, diabetes insipidus, executive functioning, and patient-reported HRQoL.
These findings suggest that young people with craniopharyngioma presenting with diabetes insipidus may benefit from targeted neurocognitive and psychosocial screening to inform interventions. What this paper adds Children with craniopharyngioma and executive functioning impairment are more likely to have poorer health-related quality of life (HRQoL). Diabetes insipidus, a complication associated with surgery, predicted greater executive functioning impairment. Diabetes insipidus indirectly predicted lower parent-reported HRQoL through executive functioning impairment.
探讨临床因素、认知障碍和嗜睡对颅咽管瘤青少年健康相关生活质量（HRQoL）的影响。
对 78 例颅咽管瘤患者（78%为白人；41 名男性，37 名女性；平均年龄 10 岁 8 个月，标准差 3 岁 11 个月，范围 6-20 岁）进行肿瘤范围和尿崩症评估。所有患者在手术切除后均进行过夜多导睡眠图和多次睡眠潜伏期试验。使用父母报告的量表评估执行功能。患者及其父母完成 HRQoL 量表。所有患者均无既往放射治疗史。
路径分析用于测试假设关系，同时控制人口统计学和疾病特征。分析显示，执行功能症状更严重的青少年患者报告的 HRQoL 更差（估计值为-0.83；p<0.001）。在尿崩症、执行功能和父母报告的 HRQoL 之间发现了直接和间接影响。尿崩症直接预测更大的总体执行功能障碍（估计值为 5.15；p=0.04），并通过执行功能障碍间接预测更低的 HRQoL（估计值为-4.25；p=0.049）。未发现日间嗜睡、肿瘤下丘脑受累、尿崩症、执行功能和患者报告的 HRQoL 之间存在显著影响。
这些发现表明，患有颅咽管瘤且存在尿崩症的年轻人可能受益于针对神经认知和心理社会的筛查，以便进行干预。本文的贡献患有颅咽管瘤且存在执行功能障碍的儿童更有可能出现较差的健康相关生活质量（HRQoL）。与手术相关的并发症尿崩症预测更大的执行功能障碍。尿崩症通过执行功能障碍间接预测较低的父母报告 HRQoL。
