The association between physical activity, sleep, and quality of life in patients in bio-chemical remission from Cushing’s syndrome

Abstract

Purpose Cushing's syndrome can negatively affect patient's quality of life (QoL) after treatment and remission. Exposure to increased cortisol over time can result in visceral obesity, which makes this population vulnerable to cardiovascular risk factors associated with visceral obesity. Sleep disturbances are present in patients in remission from Cushing's syndrome, impacting QoL. Moderate intensity physical activity performed 3 times a week decreases visceral obesity and improves sleep quality, therefore, engaging in physical activity after remission may improve patient's QoL. The current study aims to explore the association between sleep quality, physical activity, and QoL in patients in remission of Cushing's syndrome. Methods Patients in biochemical remission from Cushing's syndrome (N = 147) were recruited through the Cushing's Support and Research Foundation. Quality of life was assessed using the Cushing Quality of Life Questionnaire (CushingQoL), sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI), and physical activity levels were assessed with the Godin-Sheppard Leisure-Time Physical Activity Questionnaire (GSLTPAQ). Results Sleep quality was significantly associated with both subscales of the CushingQoL (both p < .001), but physical activity was not significantly associated with either subscale. Sleep was not significantly associated with physical activity engagement in this sample. Conclusion Results suggest that patients in remission from Cushing's syndrome experience sleep disturbances that are significantly associated with impaired QoL. Future research should focus on ameliorating the persisting clinical features of Cushing's syndrome that are associated with impaired QoL after biochemical remission to improve QoL and expedite complete functional remission.

Holistic burden of illness in patients with endogenous Cushing's syndrome: A systematic literature review

“…Eight (22%) studies reported pre−/post‐surgery outcomes 18,19,37,38,42,43,47,48 . Thirty‐one (84%) studies reported HRQoL using validated patient reported outcome (PRO) measures 15,16,19,21,23–45,55–57 . A comprehensive list of the PRO measures used to measure the outcomes was recorded (Table A4).…”

“…CS specific HRQoL was evaluated in 18 (49%) studies using three different PRO measures—CushingQoL questionnaire, Tuebingen Cushing's Disease Quality of Life Inventory (Tuebingen CD‐25) and QoL‐Cushing's disease (QoL‐CD) 19,22–24,26,29–31,33–40,42,43,46 . CushingQoL is a 12‐item, CS‐specific HRQoL PRO that examines patients' HRQoL over the past 4 weeks 8 .…”

“…Following a comprehensive review of the 246 titles and abstracts, 74 (30%) studies were selected for further full‐text review, of which 45 (18% of 246) studies met criteria for qualitative synthesis of the literature (Figure 1 ). 7 , 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 Studies were excluded for a variety of reasons throughout the screening process, including but not limited to, the study population, study design or outcomes being out of scope and thus not of interest to the authors (Figure 1 ).…”

“… 18 , 19 , 37 , 38 , 42 , 43 , 47 , 48 Thirty‐one (84%) studies reported HRQoL using validated patient reported outcome (PRO) measures. 15 , 16 , 19 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 55 , 56 , 57 A comprehensive list of the PRO measures used to measure the outcomes was recorded (Table A4 ). Of the 31 (84%) studies, 10 (32%) used 1 PRO measure, 7 (23%) used 2 different PRO measures, 6 (19%) used 3 different PRO measures and 6 (19%) used 5 or more different PRO measures.…”

Quality of life impairment after a diagnosis of Cushing’s syndrome

“…In the last decades these most distressing neurocognitive complaints have been increasingly described, like loss of memory, difficulties in concentration, coping with emotions and with executive functions, intolerance to stress, emotional incontinence, irritability, anxiety and depression, that negatively impact on health-related quality of life (QoL), which despite improving after adequate therapy to control hypercortisolism, may not normalize [ 1 – 6 ]. Furthermore, other persisting problems like sleep disturbances, fatigue, muscle weakness and permanent weight gain contribute to explain why patients with “cured” Cushing disease (CD) or any kind of endogenous Cushing syndrome (CS) still do not feel well [ 2 – 7 ].…”