Background: In the general population, sleep disorders are associated with an increased risk of cognitive impairment; moreover, people with dementia often have sleep disturbances. The prevalence of sleep disorders, such as sleep apnea, in acromegalic patients is higher than in the general population, and they may have a higher risk of cognitive impairment due to acromegaly treatment (i.e. Radiotherapy) or cardiovascular comorbidities. In the literature, data about the relationship between sleep disorders and cognitive dysfunction in acromegaly are scant.
Aim: We aim to study the relationship between sleep disturbances and cognitive dysfunction in a group of acromegalic patients.
Methods: We studied 67 consecutive acromegalic patients at different stages of the disease. We performed a neurocognitive assessment with the following tests: Babcock Story Recall Test, Digit Span Test forward and backward, Corsi Block-Tapping test forwards and backwards, Complex Figure Test, Stroop Color and Word Test, Frontal Assessment Battery, Trail Making Test, phonemic and semantic fluency. Patients also completed the Acromegaly Quality of Life Questionnaire (AcroQoL), Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index. We also collected clinical, endocrinological, and metabolic data.
Results: Of the 67 acromegaly patients in the study, 38.8% were male, median age of diagnosis was 45 years (interquartile range IQR 35, 53), median age at the neurological examination was 56 (IQR 48, 65) and mean IGF-1 was 441.88 ug/L (3 patients were first diagnosis, 4 patients had a cured disease). Most participants performed within the normal range of cognitive tests, however, approximately 6-10% were impaired, depending on the test. In linear regression models adjusted for age, sex, BMI, disease duration, and disease activity, poorer sleep quality was associated with lower global cognitive z-score (B=−0.03, 95% CI −0.06, −0.002). Daytime somnolence was associated with poorer physical QoL subscore (B=−0.04, 95% CI −0.08, −0.002). Sleep quality was associated with poorer overall QoL (B=−0.03, 95% CI −0.05, −0.006), physical QoL (B=−0.04, 95% CI −0.07, −0.005), psychological QoL (B=−0.02, 95% CI −0.04, −0.001), and social QoL (B=−0.02, 95% CI −0.04, −0.0009).
Conclusions: In acromegaly, we found that poor sleep quality is associated with lower QoL, and some evidence that is associated with lower cognitive function.
18 May 2019 - 21 May 2019