title: Somnolence in adult craniopharyngioma patients is a common, heterogeneous condition that is potentially treatable.
abstract: OBJECTIVE
  Somnolence and obesity are prevalent in craniopharyngioma patients. We hypothesized that somnolence was because of obstructive sleep apnoea in craniopharyngioma patients.
  
  
  METHODS
  We assessed prevalence of somnolence and sleep apnoea in 28 craniopharyngioma and 23 obese controls attending a tertiary referral centre, by means of the Epworth Sleepiness Score (ESS) and polysomnography. All subjects with sleep apnoea were offered continuous positive airway pressure therapy (CPAP) or modafinil. All craniopharyngioma patients, with unexplained somnolence, were offered modafinil.
  
  
  RESULTS
  Somnolence was reported by 20/28 (71·5%) craniopharyngioma patients and 4/23 (17%) obese subjects (P < 0·001). Median ESS was 7·5 (IQR 6, 10·7) in craniopharyngioma patients and 4·0 (4,8) in controls, P < 0·01. Eleven somnolent craniopharyngioma patients had obstructive sleep apnoea, in whom treatment led to a reduction in ESS by 6·4 ± 1·4, P = 0·01. Among the remaining nine patients, five were offered modafinil therapy, of whom four had benefit, three were not compliant with hormone replacement, and one died before intervention. There was no difference in the prevalence of obstructive sleep apnoea between craniopharyngioma (n = 13, 46%) and obese subjects (n = 14, 61%, P = 0·4). Body mass index (BMI) does not correlate with apnoea hypopnoea index [apnoea - hypopnoea index (AHI), r = 0·25, P = 0·08], which suggests that obesity alone does not explain the prevalence of sleep apnoea in craniopharyngioma patients.
  
  
  CONCLUSIONS
  Somnolence is common in craniopharyngioma patients and in the majority is because of obstructive sleep apnoea. An additional group of somnolent craniopharyngioma patients benefits from modafinil.
authors.affiliation: Department of Academic Endocrinology, Beaumont Hospital, Dublin 9, Ireland.
authors.forename: R K
authors.initials: RK
authors.lastname: Crowley
authors.forename: C
authors.initials: C
authors.lastname: Woods
authors.forename: M
authors.initials: M
authors.lastname: Fleming
authors.forename: B
authors.initials: B
authors.lastname: Rogers
authors.forename: L A
authors.initials: LA
authors.lastname: Behan
authors.forename: E P
authors.initials: EP
authors.lastname: O'Sullivan
authors.forename: T
authors.initials: T
authors.lastname: Kane
authors.forename: A
authors.initials: A
authors.lastname: Agha
authors.forename: D
authors.initials: D
authors.lastname: Smith
authors.forename: R W
authors.initials: RW
authors.lastname: Costello
authors.forename: C J
authors.initials: CJ
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D045422:Continuous Positive Airway Pressure; D003397:Craniopharyngioma / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077408:Modafinil; D010911:Pituitary Neoplasms / Q000150:complications*; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D000077408:Modafinil