Romigi Andrea, Feola Tiziana, Cappellano Simone, De Angelis Michelangelo, Pio Giacomo, Caccamo Marco, Testa Federica, Vitrani Giuseppe, Centonze Diego, Colonnese Claudio, Esposito Vincenzo, Jaffrain-Rea Marie-Lise
Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy.
Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Front Neurol. 2022 Feb 9;12:817257. doi: 10.3389/fneur.2021.817257. eCollection 2021.
Sleep disorders (SDs) represent an important issue in patients with craniopharyngioma (CP). Nearly 70% of these patients complain of sleep-wake cycle alterations and/or excessive diurnal somnolence due to sleep-related breathing disorders, such as obstructive sleep apnea (OSA) and/or central hypersomnia, including secondary narcolepsy. SDs may severely reduce quality of life, increase disease-related cardiorespiratory and cardiovascular morbidity, and finally play a major role in increased long-term mortality reported on patients with CP. A major risk factor for SDs is represented by the hypothalamic syndrome, which may develop because of direct hypothalamic damage by the tumor itself and/or complications of the treatments, neurosurgery and/or radiotherapy, and typically includes permanent neuroendocrine dysfunctions, morbid obesity, and secondary metabolic disorders. Despite increasing attention to SDs in the general population, and in particular to OSA as a risk factor for cardio-metabolic diseases and excessive daytime somnolence, sleep evaluation is still not routinely proposed to patients with CP. Hence, SDs are often underdiagnosed and undertreated. The aim of this paper is to update current knowledge of the pathogenesis and prevalence of SDs in patients with CP and propose practical algorithms for their evaluation and management in clinical practice. Particular attention is paid to screening and diagnostic tools for appropriate characterization of SDs, identification of risk factors, and potential role of hypothalamic sparing surgery in the prevention of morbid obesity and SDs. Available tools in sleep medicine, including lifestyle interventions, drugs, and respiratory devices, are discussed, as well as the importance of optimal hormone replacement and metabolic interventions. Current limits in the diagnosis and treatment of SDs in patients with CP and possible future avenues for research agenda are also considered.
睡眠障碍（SDs）是颅咽管瘤（CP）患者的一个重要问题。这些患者中近70%抱怨睡眠-觉醒周期改变和/或由于睡眠相关呼吸障碍导致的日间过度嗜睡，如阻塞性睡眠呼吸暂停（OSA）和/或中枢性失眠，包括继发性发作性睡病。睡眠障碍可能会严重降低生活质量，增加与疾病相关的心肺和心血管发病率，并最终在CP患者报告的长期死亡率增加中起主要作用。睡眠障碍的一个主要危险因素是下丘脑综合征，它可能由于肿瘤本身对下丘脑的直接损害和/或治疗（神经外科手术和/或放疗）的并发症而发生，通常包括永久性神经内分泌功能障碍、病态肥胖和继发性代谢紊乱。尽管普通人群对睡眠障碍的关注度不断提高，尤其是对作为心脏代谢疾病和日间过度嗜睡危险因素的阻塞性睡眠呼吸暂停，但仍未对CP患者常规进行睡眠评估。因此，睡眠障碍往往诊断不足且治疗不足。本文的目的是更新目前关于CP患者睡眠障碍的发病机制和患病率的知识，并提出在临床实践中对其进行评估和管理的实用算法。特别关注用于准确描述睡眠障碍、识别危险因素以及下丘脑保留手术在预防病态肥胖和睡眠障碍中的潜在作用的筛查和诊断工具。讨论了睡眠医学中的现有工具，包括生活方式干预、药物和呼吸设备，以及最佳激素替代和代谢干预的重要性。还考虑了CP患者睡眠障碍诊断和治疗的当前局限性以及未来研究议程可能的途径。
