Reduced sleep quality and depression associate with decreased quality of life in patients with pituitary adenomas

Abstract

Objectives: Several studies reported decreased quality of life (QoL) and sleep as well as increased rates of depression for patients with pituitary adenomas. Our aim was to explore to what extent differences in depression and sleep quality contribute to differences in QoL between patients with pituitary adenomas and controls. Design: A cross-sectional case-control study. Setting: Endocrine Outpatient Unit of the Max Planck Institute of Psychiatry, Munich, Department of Internal Medicine, Ludwig-Maximilians-University, Munich, and the Institute of Clinical Psychology and Psychotherapy, Technical University, Dresden. Participants: Patients with pituitary adenomas (nZ247) and controls (from the DETECT cohort, a large epidemiological study in primary care patients) matched individually by age and gender (nZ757). Measurements: Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and QoL was measured by the generic EQ-5D and calculated by the time trade-off-and VAS-method. Depression was categorized as 'no depression', 'subclinical depression', and 'clinical depression' according to the Beck Depressions Inventory for patients and the Depression Screening Questionnaire for control subjects. Statistical analyses: General linear and generalized, logistic mixed models as well as proportional odds mixed models were calculated for analyzing differences in baseline characteristics and in different subgroups. Results: Patients with pituitary adenomas showed decreased QoL (VAS index: 0.73G0.19) and sleep (PSQI score: 6.75G4.17) as well as increased rates of depression (subclinical or clinical depression: 41.4%) compared with their matched control subjects (VAS index: 0.79G0.18, PSQI score: 5.66G4.31, subclinical or clinical depression: 25.9%). We have shown that a substantial proportion of the reduced QoL (48% respectively 65%) was due to the incidence of depression and reduced sleep quality. Conclusions: These findings emphasize the importance of diagnosing depressive symptoms and sleep disturbances in patients with pituitary disease, with the ultimate goal to improve QoL in patients with pituitary adenomas.

MANAGEMENT OF ENDOCRINE DISEASE: Quality of life tools for the management of pituitary disease

“…This QoL impairment is worse in women (73). Additionally, sleeping difficulties namely increased slow-wave sleep compared to healthy controls may also impair QoL in prolactinoma patients (6,74).…”

Comparison of sleep quality and sleepiness in patients operated for pituitary adenoma and in healthy individuals

“…We see that impaired sleep quality in pituitary adenomas reduces the quality of life of the patient and leads to problems that can lead to depression (14). Leistner et al reported they evaluated the deteriorating performance of patients whose quality of life was impaired due to sleepiness during the day in patients who underwent pituitary adenoma surgery and there was no statistically significant difference between them and normal healthy individuals (14). In 2014, Barbosa et al conducted polysomnography in their study of 35 patients at the 6 th month controls and found that prolactinoma and hypogonadism were the predisposing factors for the obstructive sleep apnea in this study and that the sleep quality was deteriorated after medical treatment due to developing obesity in these patients with sleepiness affecting the daytime performance (2).…”

“…We see that impaired sleep quality in pituitary adenomas reduces the quality of life of the patient and leads to problems that can lead to depression (14). Leistner et al reported they evaluated the deteriorating performance of patients whose quality of life was impaired due to sleepiness during the day in patients who underwent pituitary adenoma surgery and there was no statistically significant difference between them and normal healthy individuals (14).…”

“…Depressive mood and reduced sleep quality, which are likely predictors of quality of life in these patients, have often been neglected. The relationship between pituitary adenomas and sleep disorders has previously been shown in the literature (8,14). However, after surgery of pituitary adenomas, whether sleep quality and sleepiness of these individuals are different from those of healthy subjects has not been evaluated.…”

Quality of life is significantly impaired in both secretory and non‐functioning pituitary adenomas

“…Although sometimes cortisol or prolactin levels do not correlate with disease severity, previous studies have implicated both prolactin and cortisol on human behaviour with multiple psychosomatic implications . For example, reduction in hippocampus volume, with progressive cognitive decline, increased risk of developing psychiatric illnesses such as depressive symptoms, anxiety‐related disorders and borderline personality disorder . Also, higher cortisol levels have been significant related to poor self‐esteem, low internal locus of control, loneliness and sleep deprivation; while reduction in serum cortisol has been related to positive affect demonstrated after aggregating momentary experiences throughout a working or leisure day .…”