Compression of the optic chiasm is associated with permanent shorter sleep duration in patients with pituitary insufficiency.

Abstract

OBJECTIVE: Patients with pituitary insufficiency often experience some degree of impaired sleep. Sleep-wake rhythm is regulated to a large extent by the suprachiasmatic nucleus (SCN). Because the SCN is located just superior to the optic chiasm, we hypothesized that a history of compression of the optic chiasm (CC) due to a tumour with suprasellar extension is associated with altered sleep patterns in patients with pituitary insufficiency. DESIGN: Case-control study. PATIENTS: We studied 38 patients (mean age 55.7 +/- 13.1 years; 71.1% men) with CC and 18 patients (mean age 53.3 +/- 16.6 years, 38.9% men) without CC. MEASUREMENTS: Objective measures of sleep patterns were assessed by wrist actigraphy. Validated sleep questionnaires were used to evaluate subjective sleep parameters. RESULTS: Objective total sleep duration was 36 min shorter in patients with CC than in patients without CC [454 (295-553) vs 490 (432-740) min, P = 0.034]. Moreover, patients with CC had a later habitual bedtime [23:15 (22:30-03:00) vs 22:55 (20:00-02:00) h, P = 0.044] and a later actigraphic sleep onset [23:57 (22:31-01:33) vs 23.16 (19:47-03:04) h, P = 0.020]. Linear regression analysis confirmed the difference in total sleep duration after adjustment for age, sex, body mass index, cranial radiotherapy and pituitary/hypothalamic surgery. Subjective sleep parameters were similar in both groups. CONCLUSIONS: Compression of the optic chiasm due to a tumour with suprasellar extension is associated with permanent changes in total sleep duration in patients with pituitary insufficiency.