title: Improvement of sleep disturbance and insomnia following parathyroidectomy for primary hyperparathyroidism.
abstract: BACKGROUND
  The aim of the present study was to investigate the incidence of sleep disturbance and insomnia in patients with primary hyperparathyroidism (PHPT), and to evaluate the effect of parathyroidectomy.
  
  
  METHODS
  A questionnaire was prospectively administered to adult patients with PHPT who underwent curative parathyroidectomy over an 11-month period. The questionnaire, administered preoperatively and 6 months postoperatively, included the Insomnia Severity Index (ISI) and eight additional questions regarding sleep pattern. Total ISI scores range from 0 to 28, with >7 signifying sleep difficulties and scores >14 indicating clinical insomnia.
  
  
  RESULTS
  Of 197 eligible patients undergoing parathyroidectomy for PHPT, 115 (58.3 %) completed the preoperative and postoperative questionnaires. The mean age was 60.0 ± 1.2 years and 80.0 % were women. Preoperatively, 72 patients (62.6 %) had sleep difficulties, and 29 patients (25.2 %) met the criteria for clinical insomnia. Clinicopathologic variables were not predictive of clinical insomnia. There was a significant reduction in mean ISI score after parathyroidectomy (10.3 ± 0.6 vs 6.2 ± 0.5, p < 0.0001). Postoperatively, 79 patients (68.7 %) had an improved ISI score. Of the 29 patients with preoperative clinical insomnia, 21 (72.4 %) had resolution after parathyroidectomy. Preoperative insomnia patients had an increase in total hours slept after parathyroidectomy (5.4 ± 0.3 vs 6.1 ± 0.3 h, p = 0.02), whereas both insomnia patients and non-insomnia patients had a decrease in the number of awakenings (3.7 ± 0.4 vs 1.9 ± 0.2 times, p = 0.0001).
  
  
  CONCLUSIONS
  Sleep disturbances and insomnia are common in patients with PHPT, and the majority of patients will improve after curative parathyroidectomy.
authors.affiliation: Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, K3/704 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA, smurray@uwhealth.org.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Murray
authors.forename: Priya R
authors.initials: PR
authors.lastname: Pathak
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Schaefer
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000601:surgery*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D011446:Prospective Studies; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome