title: Cushing's syndrome is associated with sleep alterations detected by wrist actigraphy.
abstract: BACKGROUND
  The association between the hypothalamic-pituitary-adrenal (HPA) axis and sleep is well described. It is also known that HPA axis disturbances have an effect on sleep. In fact, patients affected by Cushing's syndrome (CS) often complain about poor sleep quality. Our aim was to evaluate objective sleep quality and duration in patients with Cushing's syndrome in active phase, using wrist actigraphy.
  
  
  METHODS
  In 12 patients with active CS without ongoing specific therapy (11 F, 1 M; age 40.0 ± 10.9 years; BMI 28.4 ± 6.7 kg/m(2)) and 12 healthy control subjects (HS) (11 F, 1 M; age 44.0 ± 11.0 years; BMI 23.9 ± 4.2 kg/m(2)) an actigraphic evaluation was performed on 3 consecutive days under free living conditions. Objective measurement of sleep duration and quality was estimated by an actiwatch, which is a wristwatch-like device used to detect motor activity.
  
  
  RESULTS
  In CS patients, wrist actigraphy showed higher fragmented sleep (fragmentation index CS 16.2 ± 4.2, HS 13.0 ± 3.6; p = 0.034) and increased nocturnal motor activity (total activity score CS 8318 ± 4308, HS 4971 ± 2372; p = 0.020; mean activity score CS 8.7 ± 4.2, HS 5.4 ± 2.2; p = 0.030; mean score in active time CS 104.8 ± 39.2, HS 74.8 ± 23.1; p = 0.030). On the contrary, actual sleep time resulted similar in CS and HS. No correlation was found between sleep alterations and urinary free cortisol in patients.
  
  
  CONCLUSIONS
  The impaired actigraphic parameters described in our study suggest that hypercortisolism is associated with sleep alterations, which could contribute to the worsening of life quality and metabolic comorbidities associated with CS. These results have to be confirmed in a larger cohort of patients, using more accurate instruments for sleep assessment.
authors.affiliation: Division of Oncologic Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: D'Angelo
authors.affiliation: Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Beccuti
authors.affiliation: Division of Oncologic Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Berardelli
authors.affiliation: Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Karamouzis
authors.affiliation: Division of Oncologic Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Clizia
authors.initials: C
authors.lastname: Zichi
authors.affiliation: Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.|Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Giordano
authors.affiliation: Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Marco Alessandro
authors.initials: MA
authors.lastname: Minetto
authors.affiliation: Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Maccario
authors.affiliation: Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Ezio
authors.initials: E
authors.lastname: Ghigo
authors.affiliation: Division of Oncologic Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy. emanuela.arvat@unito.it.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Arvat
mesh_terms: D056044:Actigraphy; D000328:Adult; D003480:Cushing Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000473:pathology; D012890:Sleep / Q000502:physiology*; D014953:Wrist
keywords: Actigraphy; Cushing’s syndrome; Hypercortisolism; Sleep