Abstract
PurposeDisruption of sleep has great impact on quality of life. In children with a suprasellar tumor and hypothalamic-pituitary dysfunction, the circadian rhythm may be disturbed causing sleep problems. However, also other factors may influence sleep. Awareness of these different etiologies and careful history taking with appropriate additional diagnostics will aid in restoring sleep quality.MethodsWe present the workup of 4 cases with a suprasellar tumor and disturbances of sleep initiation, sleep maintenance, and daytime sleepiness. In parallel, we developed a flowchart, to aid clinicians in the diagnostics of sleep problems in children after treatment for a (supra) sellar brain tumor.ResultsAll four patients, known with hypopituitarism, presented with sleep complaints and increased daytime sleepiness. In all four, the cause of sleep problems showed to be different. In the first case, sleep evaluation revealed a severe obstructive sleep apnea, whereupon nocturnal ventilation was started. The second case revealed poor sleep hygiene in combination with an obsessive compulsive disorder. Sleep hygiene was addressed and psychiatric consultation was offered. Dexamphetamine treatment was started to reduce her obsessive compulsive complaints. The third case showed a delayed sleep phase syndrome, which improved by educational support. The fourth case revealed a secondary organic hypersomnia for which modafinil treatment was started.ConclusionSleep disturbances in children with hypopituitarism due to a (supra) sellar tumor can have different entities which require specific therapy. Awareness of these different entities is important to enable appropriate counseling. Referral to an expertise sleep center may be advised, if standard educational support is insufficient.
Highlights
Due to increased survival rates for children with a CNS tumor, the late effects of the tumor and its treatment are becoming more visible and more important [1]
Symptoms of a sleep disturbance in children with a tumor in the suprasellar region that have been frequently described in literature are difficulty initiating sleep, maintaining sleep, waking up earlier than desired, and increased daytime sleepiness [7, 19, 26]
Increased daytime sleepiness can be a result of disturbed circadian rhythm, reduced sleep, or of insufficient hormonal substitution
Summary
Due to increased survival rates for children with a CNS tumor, the late effects of the tumor and its treatment are becoming more visible and more important [1]. Sleepiness was present in the morning and evening, which resulted in falling asleep in public places, with extreme difficulty to be woken up Both the PSG with capnography and melatonin test (Tables 1 and 2) showed normal results, with no indication for a obstructive sleep apnea syndrome or a circadian rhythm disorder. Based on her sleep wake calendar and history taking, she met the criteria of the ICSD-3 for a chronic insomnia disorder, in which her obsessive compulsive disorder and strong urge for food in combination with poor sleep hygiene were the most important perpetuating factors. These measures improved both his daytime functioning as well stabilized his sleep rhythm with less night time awakening
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
