Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Anaesthesia, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Endocrine. 2023 Aug;81(2):379-387. doi: 10.1007/s12020-023-03410-x. Epub 2023 Jun 2.
Cognitive function in patients with primary hyperparathyroidism (PHPT) may be affected and be identified to have been linked to the level of parathyroid hormone (PTH). Previous studies have suggested that patients with PHPT present poor sleep quality, which might interact with cognitive decline. The purpose of this study was to determine whether sleep quality mediates the association between PTH level and cognitive function and investigate whether surgery improves sleep quality and cognition in PHPT patients.
Between June 2019 and August 2022, we recruited 146 patients diagnosed with PHPT (n = 146). We collected clinical data from medical records and evaluated sleep quality and cognition preoperatively and 2 months postoperatively by using the Pittsburgh Sleep Quality Index and Min-Mental State Examination. We examined the mediation effects of sleep disturbance and latency on correlations between PTH level and cognitive impairment by using the Bootstrap method.
The sleep quality and cognitive function were correlated with PTH level before surgery. Sleep latency or sleep disturbance exhibited a partial mediating effect on the association between PTH level and MMSE scores in PHPT patients (p < 0.05). In PHPT patients, there was a significant decline in PTH levels and an improvement in cognitive function post-surgery compared to pre-surgery, but no significant differences in sleep quality.
Sleep disturbance and sleep latency may mediate the association between PTH level and cognitive impairment in PHPT before surgery. The surgery could reduce PTH levels and improve cognition, but might not improve sleep quality in PHPT patients.
原发性甲状旁腺功能亢进症（PHPT）患者的认知功能可能受到影响，并发现与甲状旁腺激素（PTH）水平有关。先前的研究表明，PHPT 患者的睡眠质量较差，这可能与认知能力下降相互作用。本研究旨在确定睡眠质量是否在 PTH 水平与认知功能之间的关联中起中介作用，并探讨手术是否能改善 PHPT 患者的睡眠质量和认知功能。
我们于 2019 年 6 月至 2022 年 8 月期间招募了 146 名被诊断为 PHPT 的患者（n=146）。我们从病历中收集了临床数据，并在术前和术后 2 个月使用匹兹堡睡眠质量指数和简易精神状态检查评估了睡眠质量和认知功能。我们使用 Bootstrap 方法检验了睡眠障碍和潜伏期对 PTH 水平与认知障碍相关性的中介效应。
手术前，睡眠质量和认知功能与 PTH 水平相关。在 PHPT 患者中，睡眠潜伏期或睡眠障碍对 PTH 水平与 MMSE 评分之间的相关性具有部分中介作用（p<0.05）。与术前相比，PHPT 患者术后 PTH 水平显著下降，认知功能改善，但睡眠质量无显著差异。
在手术前，睡眠障碍和睡眠潜伏期可能在 PTH 水平与认知障碍之间起中介作用。手术可以降低 PTH 水平并改善认知功能，但可能不会改善 PHPT 患者的睡眠质量。
