LAUSR

Craniopharyngioma is a non-malignant tumor that arises in the suprasellar region of the intracranial compartment. Hypothalamic dysfunction is common and associated with diabetes insipidus, hormone deficiencies, neurocognitive impairment, sleep disturbance, obesity, and decreased health-related quality of life. Patients with craniopharyngioma commonly have excessive daytime sleepiness, and are often diagnosed with narcolepsy without cataplexy and even obstructive sleep apnea (OSA). This study examined the change in apnea/hypopnea index (AHI) and prevalence of disorders of hypersomnia among pediatric patients with craniopharyngioma, from the time of diagnosis to 3 years after the completion of proton therapy. A total of 110 pediatric patients diagnosed with craniopharyngioma were prospectively evaluated on a protocol of limited surgery and proton therapy or observation. Prior to proton therapy , patients age ≥4 years completed a baseline overnight polysomnography (PSG) and the next day multiple sleep latency test (MSLT) when age ≥7 years. Follow-up PSG and MSLT were repeated 3 years later. Patients were excluded from the analysis if they did not complete the sleep study at either time points. 71 completed the baseline and 3-year PSG/MSLT. A paired samples t-test determined the change between time points. When compared to baseline (M=1.30, SE=.22) the AHI significantly increased at the 3-year evaluation (M=3.00, SE=.60), with a difference of t=-1.69, (p=.002). Fifty-one patients completed the baseline and 3-year MSLT. At baseline, 8 patients did not exhibit a hypersomnolence disorder, 30 were diagnosed with hypersomnia due to medical disorder and 13 were diagnosed with narcolepsy due to medical disorder. At the 3-year MSLT, 2 of the 51 did not exhibit a hypersomnolence disorder, 30 were diagnosed with hypersomnia due to medical condition and 19 were diagnosed with narcolepsy due to medical condition. Pediatric patients with craniopharyngioma have disorders of hyposomnolence at diagnosis. The number impacted by hypersomnia increase with time, with the added burden of hypothalamic obesity and OSA. Interventions should be initiated early after diagnosis for promotion of wakefulness and prevention of obesity to deter the onset of OSA. This work was supported by the Cancer Center Support Grant (CA21765) from the National Cancer Institute and ALSAC.