Several studies describe sleep–wake disturbances in pediatric craniopharyngioma, but none have determined the prevalence or associated predictors of excessive sleepiness in this group after diagnosis and prior to post-operative observation or adjuvant radiotherapy. In this study, we report sleep–wake disturbances in children and adolescents with craniopharyngioma and associated clinical and treatment variables.
After surgery and prior to radiotherapy or observation, pediatric patients (n = 110) with craniopharyngioma ≥ 3 years old completed a baseline sleep clinic evaluation by a pediatric sleep specialist, polysomnography (PSG) and next-day multiple sleep latency test (MSLT). MSLT was limited to those ≥ 6 years old. Logistic regression models were used to determine the relationship between patient characteristics and the presence and type of hypersomnia.
Amongst patients completing PSG and MSLT, 80% had polygraphic evidence of excessive daytime sleepiness. Hypersomnia due to medical condition was diagnosed in 45% and narcolepsy in 35%. Overweight or obese patients were more likely to be diagnosed with hypersomnia (P = 0.012) or narcolepsy (P = 0.009). Grade 2 hypothalamic involvement (HI) at diagnosis was associated with the diagnosis of narcolepsy (P = 0.0008).
This study describes the prevalence and associated predictors of hypersomnia for patients with craniopharyngioma after surgical resection. HI was predictive of narcolepsy diagnosis, and a higher body mass index z-score was associated with hypersomnia due to medical condition and narcolepsy. We recommend that sleep assessment and intervention begin after surgical resection, especially in overweight or obese patients and those with extensive tumors.
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The MSLT is considered the “gold standard” for objective characterization of daytime sleepiness, but normative data from typically developing children and uniformly accepted cut-off values for pathological sleepiness in children are lacking. We chose a cut-off value for mean sleep latency of < 15 min in prepubescent children and < 10 min in pubescent youth. This is a deviation from the ICSD-3 recommendation (cut-off value of < 8 min), which refers to adults.
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The authors thank the patients and their families who participated in this study. This work was supported by Cancer Center Support Grant (CA21765) from the National Cancer Institute and the ALSAC.
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Mandrell, B.N., LaRosa, K., Hancock, D. et al. Predictors of narcolepsy and hypersomnia due to medical disorder in pediatric craniopharyngioma. J Neurooncol 148, 307–316 (2020). https://doi.org/10.1007/s11060-020-03519-3