Prognosis in childhood craniopharyngioma survivors hinges upon late effects such as pituitary deficiency and obesity. Observations indicate that reduced physical activity and increased daytime sleepiness might be risk factors for obesity. We analyzed the degree of daytime sleepiness in 115 childhood craniopharyngioma patients (47% obese) using Epworth sleeping scale (ESS). Thirty-five (30%) displayed increased daytime sleepiness (ESS score >10) 14 obese (26% of obese cohort). Polysomnography (PSG) and Multiple Sleep Latency Tests (MSLT) were conducted with 10 obese patients presenting increased daytime sleepiness, with only two craniopharyngioma patients revealing a sleep related breathing disorder. Four patients had repeated episodes of SOREM (sleep onset rapid eye movement), the classic PSG criterion for secondary narcolepsy. Three patients displayed hypersomnia. All but one patient qualified as acutely obese. Preliminary observations on the effect of central stimulating agents for treatment of secondary narcolepsy showed a significant beneficial effect. All four patients treated with Modafinil (daily dose 100–400mg) or Methylphenidate (daily dose 10–30mg) in terms of an individual experimental therapy showed a significant improvement of daytime sleepiness (median reduction on ESS: 3 points, ranging from 2 to 12 points) and an improved self-assessment of daily activity documented by activity diaries. We speculate that secondary narcolepsy is an exacerbating condition of childhood craniopharyngioma obesity, supported by recent reports on orexin and narcolepsy which suggest hypothalamic failure in idiopathic narcolepsy. Further studies on this hypothesis are part of the German prospective multicenter surveillance study of children and adolescents with craniopharyngioma (KRANIOPHARYNGEOM 2000; protocol at: www.kraniopharyngeom.de). Supported by Deutsche Kinderkrebsstiftung, Bonn (www.kinderkrebsstiftung.de)
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Gebhardt et al. (2006) studied this question.