Sleep disruption in patients with active and treated endogenous Cushing’s syndrome Journal Article


Authors: Geer, E. B.; Grillo, I.; Li, Q.; Robins, H.; Cohen, V.; Baratz, H.; Garcia, C.; Sazo, M.; Lin, A.; Cohen, M.; Tabar, V.; Mao, J.; Garland, S. N.
Article Title: Sleep disruption in patients with active and treated endogenous Cushing’s syndrome
Abstract: Context: The hypothalamic-pituitary-adrenal axis is a critical regulator of circadian rhythm in humans. Impaired sleep adversely affects metabolic, emotional, and cognitive health. Objective: To characterize sleep disturbances in patients with active and treated Cushing’s syndrome (CS), and identify factors associated with impaired sleep in treated patients. Design: Single-center cross-sectional study. Methods: Patients with pituitary or adrenal CS enrolled in an observational study completed Nottingham Health Profile (NHP), CushingQoL, and Hospital Anxiety and Depression assessments. Cross-sectional analysis was conducted including patients with active and treated disease. Results: 113 (94 female) patients with CS were included, 104 pituitary and 9 adrenal, with mean age at diagnosis of 43.9 ± 13.4 years. Mean and maximum duration of follow up was 5.1 and 23 years. Mean NHP sleep score was lower (i.e., improved) in patients with treated vs. active disease (29.6 ± 30.2 vs. 51.9 ± 30.9, p = 0.0005), as was CushingQoL sleep score (p = 0.015), but 41.5% of patients with treated disease stated they often or always had trouble sleeping. The proportion of treated vs. active patients taking medication for sleep, mood, or pain was not different. Neither NHP nor CushingQoL pain scores were lower in treated vs. active patients (p = 0.39 and 0.53). In patients with treated CS, anxiety and depression correlated with worse sleep scores. Conclusions: Patients with treated CS report improved sleep quality compared to those with active disease, but almost half of treated patients still report sleep challenges. The need for sleep medications, reported by one third of patients, was not different after CS treatment. Ongoing mood disturbances may play a role in persistent sleep disruption. Further work should focus on determinants of sleep impairments in treated CS patients. © The Author(s) 2024.
Keywords: adult; middle aged; major clinical study; follow up; quality of life; pain; risk factor; insomnia; depression; mood; anxiety disorder; cross-sectional study; cross-sectional studies; anxiety; hydrocortisone; sleep disorder; pain assessment; complication; cushing's syndrome; cushing syndrome; patient reported outcome; sleep quality; cushing disease; humans; human; male; female; article; sleep wake disorders; sleep disorder assessment; sleep disruption; acth-independent cushing syndrome; nottingham health profile
Journal Title: Pituitary
Volume: 27
Issue: 5
ISSN: 1386-341X
Publisher: Springer  
Date Published: 2024-10-01
Start Page: 654
End Page: 664
Language: English
DOI: 10.1007/s11102-024-01450-8
PUBMED: 39251540
PROVIDER: scopus
PMCID: PMC11513747
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Eliza B. Geer -- Source: Scopus
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MSK Authors
  1. Viviane S Tabar
    225 Tabar
  2. Jun J Mao
    244 Mao
  3. Andrew Lee Lin
    61 Lin
  4. Eliza Brevoort Geer
    50 Geer
  5. Marc A Cohen
    136 Cohen
  6. Qing Susan Li
    82 Li
  7. Christine Bernadette Beltran Garcia
    2 Garcia
  8. Isabelle Christine Grillo
    1 Grillo
  9. Maria Sazo
    1 Sazo