Sleep-Disordered Breathing Is Increased in Obese Adolescents with Craniopharyngioma Compared with Obese Controls

Context: Retrospective studies suggest that adolescents with craniopharygnioma and hypothalamic obesity have increased sleep-disordered breathing (SDB). Objectives: The objectives of this study were to compare the prevalence of SDB in adolescents with craniopharyngioma-related obesity compared with body mass index (BMI)-matched controls and to explore possible relationships between SDB, insulin resistance, and adipocytokines. Design: This was a cross-sectional study of obese craniopharyngioma and obese control adolescents. Setting: Subjects were evaluated in the clinical investigation unit at the Hospital for Sick Children, Toronto. Patients: Fifteen patients with craniopharyngioma-related obesity and 15 BMI-matched controls were recruited and tested. Interventions: Each subject underwent fasting blood work, frequent sampled iv glucose tolerance test, polysomnography, and abdominal magnetic resonance imaging with calculation of visceral and sc adipose tissue. Main Outcome Measures: Main measures included insulin sensitivity, sleep efficiency, and fragmentation. Results: Insulin sensitivity was lower in craniopharyngioma subjects compared with control subjects (0.96 +/- 0.34 vs. 1.67 +/- 0.7, P = 0.01). Sleep-onset latency (19.3 +/- 27.8 vs. 31.9 +/- 23.4, P = 0.03) and oxygen saturations (rapid eye movement sleep: 89.0 +/- 5.1 vs. 94.2 +/- 2.3, P < 0.001; non-rapid eye movement sleep: 88.4 +/- 5.6 vs. 94.3 +/- 1.5, P < 0.001) were lower in craniopharyngioma. Obstructive apnea-hypopnea index (OAHI) (7.5 +/- 9.0 vs. 1.5 +/- 1.5, P = 0.03) was higher in craniopharyngioma. Respiratory distress index and OAHI correlated negatively with adiponectin concentrations (r = -0.61, P = 0.03, r = -0.71, P = 0.006, respectively) in craniopharyngioma. On multiple regression, TNF-alpha and craniopharyngioma were independent positive predictors of sleep-onset latency and adiponectin and craniopharyngioma were significant predictors (negative and positive, respectively) of OAHI. Conclusions: SDB is increased in adolescents with craniopharyngioma-related obesity compared with BMI-matched controls. Routine polysomnography should be considered in obese patients with craniopharyngioma and appropriate treatment initiated. (J Clin Endocrinol Metab 95: 2211-2218, 2010)