Possible Mechanism of Secondary Narcolepsy with a Long Sleep Time Following Surgery for Craniopharyngioma

Sakuta, Keisuke; Nakamura, Masaki; Komada, Yoko; Yamada, Shozo; Kawana, Fusae; Kanbayashi, Takashi; Inoue, Yuichi

doi:10.2169/internalmedicine.51.6101

Cited by 17 publications

(8 citation statements)

References 13 publications

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“…Former studies have reported on a delayed secretory melatonin pattern with peaks in the daytime in patients with delayed sleep-phase syndrome (33), whereas another study has observed a relatively higher melatonin secretion during the day in narcoleptic patients (34). Even though secondary narcolepsy is rarely seen, case descriptions of secondary narcolepsy in patients with hypothalamic tumour involvement have been reported (10,13,35,36,37,38). We therefore speculate that the sleep-wake control may be involved, either via involvement of the ventral preoptic nucleus or hypocretinergic neurons located in the hypothalamus or their projections, causing disturbances in sleep regulation or rapid eye movement and non-rapid eye movement transitions.…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

Sleep–wake and melatonin pattern in craniopharyngioma patients

Pickering

Jennum

Gammeltoft

et al. 2014

European Journal of Endocrinology

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Objective: To assess the influence of craniopharyngioma or consequent surgery on melatonin secretion, and the association with fatigue, sleepiness, sleep pattern and sleep quality. Design: Cross-sectional study. Methods: A total of 15 craniopharyngioma patients were individually matched to healthy controls. In this study, 24-h salivary melatonin and cortisol were measured. Sleep-wake patterns were characterised by actigraphy and sleep diaries recorded for 2 weeks. Sleepiness, fatigue, sleep quality and general health were assessed by Multidimensional Fatigue Inventory, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Short-Form 36. Results: Patients had increased mental fatigue, daytime dysfunction, sleep latency and lower general health (all, P%0.05), and they tended to have increased daytime sleepiness, general fatigue and impaired sleep quality compared with controls. The degree of hypothalamic injury was associated with an increased BMI and lower mental health (PZ0.01). High BMI was associated with increased daytime sleepiness, daytime dysfunction, mental fatigue and lower mental health (all, P%0.01). Low midnight melatonin was associated with reduced sleep time and efficiency (P%0.03) and a tendency for increased sleepiness, impaired sleep quality and physical health. Midnight melatonin remained independently related to sleep time after adjustment for cortisol. Three different patterns of melatonin profiles were observed; normal (nZ6), absent midnight peak (nZ6) and phase-shifted peak (nZ2). Only patients with absent midnight peak had impaired sleep quality, increased daytime sleepiness and general and mental fatigue. Conclusion: Craniopharyngioma patients present with changes in circadian pattern and daytime symptoms, which may be due to the influence of the craniopharyngioma or its treatment on the hypothalamic circadian and sleep regulatory nuclei.

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Section: European Journal Of Endocrinologymentioning

confidence: 99%

Sleep–wake and melatonin pattern in craniopharyngioma patients

Pickering

Jennum

Gammeltoft

et al. 2014

European Journal of Endocrinology

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“…Although CSF hypocretin level was not measured in the present case, our patient was thought to have functional impairment of hypocretin projection rather than damaged hypocretin-containing neurons as a result of surgery, resulting in symptomatic narcolepsy. Recently, Sakuta et al 9 performed MRI tractography on a patient with symptomatic narcolepsy following surgery for craniopharyngioma. They suggested that a lack of neuronal connections had contributed to the occurrence of symptomatic narcolepsy.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Narcolepsy and Generalized Seizures Following Surgery for Rathke’s Cleft Cyst

Ryu

Lee

2014

Sleep Med Res

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Symptomatic narcolepsy is a rare disorder caused by other underlying neurological disorders. One of the most frequent causes for symptomatic narcolepsy is brain tumors, usually in the region of the third ventricle and the diencephalon. Depending on clinical profile, the mass effect or surgical removal of space occupying lesions may play a definitive causative role in the occurrence of narcolepsy symptoms. We report a woman with symptomatic narcolepsy that developed 2 years after surgical removal of Rathke's cleft cyst, which has never before been reported as a causative factor for symptomatic narcolepsy. In addition, myoclonic and/or generalized tonic-clonic seizures were associated with a left thalamic lesion generated by a complication of surgery.

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“…Furthermore, orexin suppresses REM sleep which explains the REM sleep dissociation events observed in these patients. Among patients with CNS tumors, numerous studies have reported secondary/comorbid narcolepsy in those patients with tumors involving the hypothalamic area or close to the third ventricle (Kanbayashi et al, 2006;Sakuta et al, 2012;Madan et al, 2021). Mogavero et al propose that a diagnosis of neurodegenerative disease may decrease the risk of cancer i.e., the inverse comorbidity mechanism (Mogavero et al, 2020(Mogavero et al, , 2021.…”

Section: Sleep Disorder Diagnoses and The Association With Tumor Loca...mentioning

confidence: 99%

Systematic Review: Sleep Disorders Based on Objective Data in Children and Adolescents Treated for a Brain Tumor

et al. 2022

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BackgroundTumors of the central nervous system (CNS) are the most common solid childhood malignancy. Over the last decades, treatment developments have strongly contributed to the improved overall 5-year survival rate, which is now approaching 75%. However, children now face significant long-term morbidity with late-effects including sleep disorders that may have detrimental impact on everyday functioning and quality of life. The aims of this study were to (1) describe the symptoms that lead to polysomnographic evaluation; (2) describe the nature of sleep disorders diagnosed in survivors of childhood CNS tumor using polysomnography (PSG); and (3) explore the association between tumor location and diagnosed sleep disorder.MethodsAn extensive literature search following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA) was conducted. Inclusion criteria were children and adolescents diagnosed with a CNS tumor age <20 years having a PSG performed after end of tumor treatment. The primary outcome was sleep disorder confirmed by PSG.ResultsOf the 1,658 studies identified, 11 met the inclusion criteria. All the included articles were appraised for quality and included in the analysis. Analyses indicated that sleep disorders commonly occur among childhood CNS tumor survivors. Symptoms prior to referral for PSG were excessive daytime sleepiness (EDS), fatigue, irregular breathing during sleep and snoring. The most common sleep disorders diagnosed were sleep-related breathing disorders (i.e., obstructive sleep apnea) and central disorders of hypersomnolence (i.e., narcolepsy).ConclusionOur findings point to the potential benefit of systematically registering sleep disorder symptoms among CNS tumor patients together with tumor type and treatment information, so that at-risk patients can be identified early. Moreover, future rigorous and larger scale controlled observational studies that include possible modifiable confounders of sleep disorders such as fatigue and obesity are warranted.Clinical Trial Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021243866, identifier [CRD42021243866].

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Possible Mechanism of Secondary Narcolepsy with a Long Sleep Time Following Surgery for Craniopharyngioma

Cited by 17 publications

References 13 publications

Sleep–wake and melatonin pattern in craniopharyngioma patients

Sleep–wake and melatonin pattern in craniopharyngioma patients

Symptomatic Narcolepsy and Generalized Seizures Following Surgery for Rathke’s Cleft Cyst

Systematic Review: Sleep Disorders Based on Objective Data in Children and Adolescents Treated for a Brain Tumor

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