Sleep disturbances in patients with Addison's disease

Abstract

Objective: The standard replacement therapy in Addison's disease does not restore normal nocturnal levels of the hormones of the hypothalamic -pituitary-adrenal axis. The aim of the study was to describe the prevalence and characteristics of sleep disturbances in patients with Addison's disease. Methods: Sixty patients completed a self-administered sleep questionnaire and the Epworth Sleepiness Scale (ESS) questionnaire. Activity-based monitoring (actigraph recordings) and sleep diaries were obtained from eight patients. Results: Thirty-four percent reported weekly sleep disturbances (difficulties falling asleep in 13%; repeated awakenings in 14%; early morning awakenings in 20%). The sleep need was 8.21 h (S.D. 1.34; range 6-14 h), and sleep onset latency was 29 min (S.D. 29, range 2-150 min). Forty percent of the patients were tired during daily activities more than once a week, but the scores of the ESS were 6.0 (S.D. 3.5), which is not higher than normal. The actigraph recordings showed higher sleep efficiency than the subjective recordings. Conclusion: We did not identify specific sleep disturbances which were characteristic for patients with Addison's disease. Patients with Addison's disease have increased daytime fatigue, but no more daytime sleepiness than normal.

Increased Daytime Somnolence despite Normal Sleep Patterns in Patients Treated for Nonfunctioning Pituitary Macroadenoma

“…We found in NFMA patients that deficiencies in anterior pituitary hormones, especially secondary hypothyroidism, are associated with altered sleep patterns, which is in line with findings in patients with primary hypothyroidism (29). GH deficiency or ACTH deficiency did not specifically influence sleep patterns in our study patients, in line with reports on sleep in GH deficiency (30,31) or Addison's disease (32).…”

MANAGEMENT OF ENDOCRINE DISEASE: Epidemiology, quality of life and complications of primary adrenal insufficiency: a review

“…One study showed increased prevalence of sleep disturbances in Addison's disease (46), and another indicated that glucocorticoid replacement is permissive for rapid eye movement (REM) sleep (47). One study found that, although PAI had a noteworthy direct effect on QoL, the indirect effect of sleep disruption was significantly greater (48).…”

Review: Replication of cortisol circadian rhythm: new advances in hydrocortisone replacement therapy

“…Sleep disturbances associated with increased daytime fatigue have been reported for patients with adrenal insufficiency [Lovas et al 2003]. Rapid eye movement (REM) sleep latency and time may vary in patients with adrenal insufficiency on conventional treatment this interrupting sleep continuity [Garcia-Borreguero et al 2000].…”