Sleep Architecture and Sleep Apnea in Patients with Cushing's Disease

Shipley, James E.; Schteingart, D.E.; Tandon, Rajiv; Starkman, Monica N.

doi:10.1093/sleep/15.6.514

Cited by 114 publications

(68 citation statements)

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“…69 In contrast, hypercortisolism and disturbed sleep are frequent symptoms in Cushing's disease and in depression. In Cushing's disease, SWS is decreased 70,71 with increased sleep latency, enhanced waketime, and REMS disturbances. In depressed patients in whom both cortisol and ACTH were elevated throughout the night an increased number of awakenings, early morning awakenings, decrease of NREMS, and REMS disinhibition 72 were observed.…”

Section: Cortisol Glucocorticoid and Mineralocorticoid Receptor Ligmentioning

confidence: 99%

Hormones, hormonal agents, and neuropeptides involved in the neuroendocrine regulation of sleep in humans

Kotronoulas

Stamatakis²,

Stylianopoulou³

2009

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Sleep is an essential ubiquitous biological process, a periodical state of quiescence in which there is minimal processing of sensory information and no interaction with conspecifics or the environment. Despite relevant research on sleep structure and testing of numerous endogenous sleep-affecting chemicals, questions as to the precise mechanisms and functions of sleep remain without satisfactory responses. The purpose of this review is to report on current evidence as regards the effect of several endogenous and exogenous hormones, hormonal agents, and neuropeptides on sleep onset or wake process, when administered in humans in specific doses and via different routes. The actions of several peptides are presented in detail. Some of them (growth hormone releasing hormone, ghrelin, galanin, neuropeptide Y) seem to promote sleep, whereas others (corticotropin, somatostatin) impair its continuity.

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Section: Cortisol Glucocorticoid and Mineralocorticoid Receptor Ligmentioning

confidence: 99%

Hormones, hormonal agents, and neuropeptides involved in the neuroendocrine regulation of sleep in humans

Kotronoulas

Stamatakis²,

Stylianopoulou³

2009

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“…SHIPLEY and co-workers [22,23] found sleep apnoea in 45% of their 22 patients with Cushing9s disease or Cushing9s syndrome. Long-term, high-dose corticosteroid therapy may also contribute to SDB [77].…”

Section: Cushing9s Syndrome and Cushing9s Diseasementioning

confidence: 99%

“…Sleep apnoea is common in acromegaly [12][13][14][15][16][17], hypothyroidism [18][19][20][21] or Cushing9s syndrome [22,23] (table 1). The most recent studies suggest that SDB may not only complete the clinical picture but play a central role in the pathophysiology of obesity [32], leptin resistance [33][34][35] or the metabolic syndrome [32,36,37].…”

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confidence: 99%

Sleep-disordered breathing and hormones

Saaresranta¹,

Polo²

2003

Eur Respir J

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Sleep-disordered breathing (SDB) is not only a problem of the upper airway but is a systemic condition with endocrine and metabolic interactions. The accumulating body of evidence shows that SDB induces changes in the serum levels or secretory patterns of several hormones. Conversely, various endocrine disorders and hormone therapies may induce, exacerbate or alleviate SDB.Much of the understanding of the interactions between hormones and sleepdisordered breathing derive from intervention studies with nasal continuous positive airway pressure therapy. Better understanding of hormones and breathing may open new perspectives in developing strategies to prevent, alleviate or cure sleep-disordered breathing and its systemic consequences. Eur Respir J 2003; 22: 161-172.

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“…In the patient presented here, control of blood glucose levels and metabolic control was paramount because she had other endocrinopathies that although they had opposing effects they could alter significantly her survival. Sleep apnea is more frequent in patients with Cushing's, being secondary to the associated obesity and/or myopathy and can be aggravated by the pre-anesthetic medication [21][22][23] . Therefore, the probability of difficult airways for ventilation and/or intubation was increased 24 .…”

Section: Discussionmentioning

confidence: 99%

“…Nessa paciente, em particular, o controle glicêmico e metabólico era imperativo, pois ela era portadora de afecções endócrinas que apesar de atuarem de maneiras opostas podiam alterar significativamente sua sobrevida. A apnéia obstrutiva do sono é mais freqüente em pacientes com Cushing, decorrendo da obesidade e/ou da miopatia que a acompanha e pode ser agravada pela medicação pré-anestésica [21][22][23] . Portanto, a probabilidade de haver uma via aérea difícil, seja para a ventilação ou intubação traqueal era maior 24 …”

Section: Relato Do Casounclassified

Anestesia para paciente portadora de múltiplas afecções endócrinas: relato de caso

Maciel¹,

Fernandes²,

Pereira³

2008

Rev. Bras. Anestesiol.

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BACKGROUND AND OBJECTIVES:Insulinoma is the most common pancreatic endocrine tumor and it can be associated with multiple endocrine neoplasia (MEN). This is a report on a patient with multiple endocrine abnormalities, who did not fulfill the criteria of known syndromes (MEN) and the clinical-anesthetic particularities that influenced the anesthetic management. CASE REPORT:A 23-year old female patient with episodes of hypoglycemia difficult to control, associated with Cushing's disease and prolactinoma without symptoms of pituitary compression and with normal thyroid and parathyroid. Investigation found a retroperitoneal mass of unknown origin which in face of the clinical presentation raised the hypothesis of insulinoma. The patient also referred to be a Jehovah's Witness. Biopsy of the mass by videolaparoscopy and enucleation of the insulinoma were proposed. On physical exam the patient was overweight, had protruding teeth, she was classified as Mallampati 3 and had symptoms of sleep apnea. Laboratorial exams revealed hematocrit 58%. Pre-anesthetic medication consisted of oral midazolam (7.5 mg) and clonidine (200 µg). Fentanyl (150 µg), clonidine (90 µg), propofol (150 mg) and pancuronium (8 mg) were used for anesthetic induction and she was intubated without intercurrences. Central venous access and invasive blood monitoring were instituted. Intravenous infusion of D5W with electrolytes was instituted and capillary glucose levels were monitored every 30 minutes, which did not demonstrate any episodes of hypoglycemia during the surgery. The patient remained hemodynamically stable even during the pneumoperitoneum. She developed postoperative episodes of hypoglycemia, which motivated the re-operation. CONCLUSIONS:This case is unique due to the presence of multiple endocrine abnormalities and the particularities of the surgicalanesthetic management. Intraoperative monitoring is mandatory during removal of an insulinoma to avoid incomplete tumor resection. Multiple challenges in one patient demand the knowledge, by the anesthesiologist, of each obstacle and its interactions in order to devise strategies to control them.

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Sleep Architecture and Sleep Apnea in Patients with Cushing's Disease

Cited by 114 publications

References 0 publications

Hormones, hormonal agents, and neuropeptides involved in the neuroendocrine regulation of sleep in humans

Hormones, hormonal agents, and neuropeptides involved in the neuroendocrine regulation of sleep in humans

Sleep-disordered breathing and hormones

Anestesia para paciente portadora de múltiplas afecções endócrinas: relato de caso

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