0994 Assessment Of Sleep-wake And Circadian Rhythm Disruption In Children And Adolescents Diagnosed With Craniopharyngioma

Abstract

Abstract Introduction Patients with craniopharyngioma are at increased risk for hypersomnia/narcolepsy and circadian rhythm disruption, secondary to hypothalamic-pituitary involvement of the tumor. We assessed youth with craniopharyngioma to determine presence of the dim light melatonin onset (DLMO) and concurrent sleep disturbance. Methods Fifty-two patients (7-21 years; 51% female) enrolled on our institutional protocol for craniopharyngioma that included surgery, proton therapy, or both. In-home salivary melatonin was collected after surgery and hourly beginning 3 h before to 1 h after habitual bedtime to determine the DLMO, which was defined as the time that melatonin exceeded a 4 pg/mL threshold. Polysomnography and a next day multiple sleep latency test (MSLT) were also conducted. Results Hypersomnia/narcolepsy was indicated in 86% of patients. DLMO was detected in 29 (56%) patients and averaged 21:04 (±1:14). All but 2 patients with a DLMO had a concurrent sleep diagnosis (18 hypersomnia, 8 narcolepsy, 1 insomnia). In those we could not compute a DLMO, melatonin was above the 4 pg/mL threshold in 19 (37%), suggesting that the DLMO was likely earlier than the sampling window. Two (4%) did not reach threshold, suggesting that the DLMO was later than the window. For patients in which DLMO was not computed, all but 4 had a concurrent sleep diagnosis (7 hypersomnia, 9 narcolepsy, 1 MSLT not completed). Three (6%) participants showed a pattern of melatonin decreasing before bedtime (2 hypersomnia, 1 narcolepsy). Sleep disorder diagnosis was not associated with whether a DLMO was detected or not. Conclusion DLMO did not occur within the sampling window in 44% of patients with the majority due to the DLMO likely occurring before sampling started. Simultaneous assessment of both sleep-wake disturbance and circadian phase could provide more informed sleep interventions for excessive sleepiness and circadian misalignment in this patient population. Support This study was supported by cancer center grant (CA21765) from the National Cancer Institute, and ALSAC.