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Increased Daytime Somnolence despite Normal Sleep Patterns in Patients Treated for Nonfunctioning Pituitary Macroadenoma

Departments of Endocrinology and Metabolic Diseases (A.A.v.d.K., O.M.D., A.M.P., J.A.R.), of Epidemiology (O.M.D.), and of Pulmonology of (K.W.v.K.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands

Address all correspondence and requests for reprints to: Agatha A. van der Klaauw, M.D., Department of Endocrinology and Metabolic Diseases C4-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. E-mail: a.a.van_der_klaauw{at}lumc.nl.

Objective: In patients treated for nonfunctioning pituitary macroadenoma (NFMA), increased fatigue scores on quality of life (QoL) have been reported. Because this may be related to altered sleep patterns, we evaluated daytime sleepiness and sleep patterns in patients successfully treated for NFMA in our center.

Design: This is a case-control study.

Patients and Methods: We assessed sleepiness and sleep patterns in 76 adult patients (41 men, mean age 63 yr, range 37–87) in remission of NFMA during long-term follow-up (10 yr, range 0.5–30) after surgical (n = 76) and additional radiotherapeutical (n = 28) treatment. We used two validated questionnaires for sleep parameters (Epworth Sleepiness Scale and Münchener Chronotype Questionnaire) and four validated questionnaires for QoL (Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory-20, Nottingham Health Profile, and Short Form-36). Patient outcomes were compared with 76 healthy controls.

Results: Sleep duration and timing of sleep were not affected compared with healthy controls. However, sleepiness score was increased in patients compared with controls (7.6 ± 4.6 vs. 4.8 ± 3.1; P < 0.001), reflecting increased daytime sleepiness in patients. There were no correlations between any of the sleep pattern parameters (duration, onset, rise time, or midsleep) and sleepiness scores. Sleepiness scores were significantly correlated to 15 of the 21 QoL parameters, whereas sleep patterns were not. Sleep timing was influenced by previous radiotherapy, whereas sleep duration was negatively affected by panhypopituitarism.

Conclusion: Daytime sleepiness is increased despite normal sleep patterns in patients treated for NFMA.