AUTHOR=Romigi Andrea , Feola Tiziana , Cappellano Simone , De Angelis Michelangelo , Pio Giacomo , Caccamo Marco , Testa Federica , Vitrani Giuseppe , Centonze Diego , Colonnese Claudio , Esposito Vincenzo , Jaffrain-Rea Marie-Lise 

TITLE=Sleep Disorders in Patients With Craniopharyngioma: A Physiopathological and Practical Update

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.817257

DOI=10.3389/fneur.2021.817257

ISSN=1664-2295

ABSTRACT=Sleep disorders (SDs) represent an important issue in craniopharyngioma (CP) patients. Nearly 70% of these patients complain of sleep-wake cycle alterations and/or excessive diurnal somnolence due to sleep-related breathing disorders – such as obstructive sleep apnea (OSA) – and/or central hypersomnia –, including secondary narcolepsy -. SDs may severely reduce quality of life, increase disease-related cardio-respiratory and cardiovascular morbidity, and finally play a major role in the increased long-term mortality reported in CP patients. A major risk factor for SDs is represented by the hypothalamic syndrome, which may develop due to the direct hypothalamic damage by the tumor itself and/or to the complications of the treatment – neurosurgery and/or radiotherapy -, and typically includes permanent neuroendocrine dysfunctions, morbid obesity and secondary metabolic disorders. Despite the increasing attention to SDs in the general population, and in particular to OSA as a risk factor for cardio-metabolic diseases and excessive daytime somnolence, sleep evaluation is still not routinely proposed to CP patients. Hence, SDs are often underdiagnosed and undertreated. The aim of this paper is to update current knowledge about the pathogenesis and prevalence of SDs in CP patients and to propose practical algorithms for their evaluation and management in clinical practice. Particular attention is paid to screening and diagnostic tools for an appropriate characterization of SDs, the identification of risk factors and the potential role of hypothalamic sparing surgery in the prevention of morbid obesity and SDs. Available tools in sleep medicine, including lifestyle interventions, drugs and respiratory devices, are discussed, as well as the importance of optimal hormone replacement and metabolic interventions. Current limits in the diagnosis and treatment of SDs in CP patients and possible future avenues for research agenda are also considered.