This study reported that sleep disturbances was common in Chinese primary PA patients, with 47.8% of patients suffered from poor sleep. Alcohol use and MFI-general fatigue were independent predictors of poor sleep quality in primary PA patients. What is more, poor PA sleepers had impaired HRQoL than good PA sleepers. To our knowledge, this study is the first to examine the contributing factors of sleep disturbances and the impact of sleep disturbances on the quality of life in Chinese primary PA patients.
It is reported that the occurrence of sleep disturbances is affected by a series of social and demographic factors[24]. Our study indicated that alcohol use was one of the significant risk factors for sleep quality. Alcohol disrupts sleep through multiple mechanisms, such as disrupting electrophysiologic sleep architecture, contributing to abnormalities of circadian rhythms, triggering insomnia, and short sleep duration in cross-sectional studies [25]. Epidemiologic studies have shown that alcohol use is associated with insomnia symptoms in different populations such as community adults [26], Veterans [27], and older adults[28]. The reason might be that alcohol disrupts circadian timing via effects on photic and non-photic phase-resetting[29]. It can be seen that sleep quality is linked to alcohol use. Therefore, it is necessary to enhance the assessment of lifestyle habits in patients with primary PA, such as asking patients about their symptoms, signs, and alcohol consumption, and assessing the reasons for alcohol consumption. Some cognitive interventions can be taken to help patients recognize the impact of drinking behavior on their sleep or quality of life. Multiple approaches are taken to give healthy lifestyle guidance, provide effective ways to reduce alcohol consumption, encourage patients to try them, and enlist the support of their families.
More and more studies have shown that mental disorders are a risk factor for sleep quality[30]. Reports show that most major AP patients have serious emotional problems[31, 32]. Mental disorders, especially irritability and depression, and it may aggravate PA related health-related comorbidities, such as sleep disorders and quality of life limitations[33, 34].Some scholars investigated sleep quality and analyzed the impact of emotional problems on postoperative sleep quality changes in acromegaly patients. And they found that higher scores for anxiety, disease stigma were correlated with worse sleep quality in acromegaly patients[35].These evidences sustained that there is a bidirectional connection between these two variables which is a vicious cycle. In the present study also indicate that patients with poor sleep had significantly higher levels of HADS-A and HADS-D scores compared to those with good sleep. These suggest that health care providers should pay attention to the psychological status of patients with PA. While focusing on the treatment and surgical modalities of primary PA patients, there is a need for systematic psychiatric screening and management, as well as targeted interventions to help primary PA patients improve their sleep quality. For example, including sleep control, sleep education and cognitive behavior, can be used to improve physical and mental health and sleep quality[36] [37].
According to relevant literature, some disease-related factors are associated with sleep quality among the patients with brain tumor[38, 39]. And our study has shown that the patients with poor sleep have significantly serious physical symptoms and suffer more troubles in daily life as compared with those with good sleep. The patients with sleep disorders have more serious physical symptoms, e.g., headache, restlessness, poor appetite, drowsiness, irritability, weakness, and changes in stool habits. Many studies have verified the close relationship between physical symptoms and sleep, i.e., high comorbidity between the two. Headache may disrupt sleep and a poor sleep is able to worsen headache[40]. Previous scholars also reported that sleep disorders and headache cause and/or exacerbate each other in a complex, bidirectional manner, which is largely determined by the shared neurobiological substrate and is also mediated by emotional and personality disorders[41]. Furthermore, we found that among the patients with nausea and vomiting, the sleep quality was even worse. Previous studies also reported that nausea might worsen the sleep quality[42]. Moreover, people with poor sleep quality got high scores for interferences, including general activities, mood, work, and housework. This has indicated that there is a significant correlation between physical symptoms and sleep. The more serious the physical symptoms and the more the interferences in daily life, the more serious the harm to the sleep of the patients. Medical workers should have specific individualized measures for those patients, thus alleviating their sleep disorders through improving the main symptoms for relevant diseases, and break the vicious circle for mutual promotion between physical symptoms and sleep disorders.
Fatigue is one of the common symptoms in many patients with tumors and chronic diseases. The clinical symptom of fatigue may include generalized weakness, decreased mental concentration, insomnia or hypersomnia, and emotional change that cause significant impairment to the global quality of life of patients[43]. Fatigue is one of the most common symptoms and is one of the most common symptoms in patients with primary tumor (including primary brain tumor). Cross sectional study shows that fatigue is the most common symptom and 40–70% of patients with primary brain tumors express fatigue in the overall medical record[44]. Several authors examined the fatigue frequency of patients with glioblastoma and showed that these patients were usually affected by such symptoms[45]. Fatigue is also reported by more than 80% of patients with primary brain tumor during radiotherapy[46]. The findings of this study also showed that primary PA patients had higher fatigue, with a mean fatigue score of 60.09 ± 12.18. In addition, fatigue played a key role in sleep disturbance in primary PA patients. It is noteworthy that patients with meningioma, both benign brain tumors, also have trouble sleeping, and fatigue is associated with sleep disturbance[47]. Additionally, logistic regression analysis indicated that MFI-general fatigue was a major contributor to sleep quality, which is consistent with previous studies[48, 49, 38]. These studies revealed a link between sleep perception quality and fatigue reporting. On average, people who participated in the activity had better sleep quality, harrier et al reported, And the tendency to report lower average fatigue levels [50]. Fatigue and insomnia are common problems in the general population and in the patient population with primary brain tumors. However, there is no gold-standard for fatigue treatment, possibly due to its multifactorial etiology and lack of knowledge of underlying mechanisms. Given the impact of fatigue and insomnia on function and quality of life, focused studies are needed to explore the biologic basis of both fatigue and insomnia in this patient population. Greater insight into the underlying biologic mechanisms of these important symptoms will permit the development of specific interventions that may either prevent or treat these symptoms.
Nowadays, the growing number of studies assessing HRQoL generally described the negative impact of pituitary adenomas. Long term study on patients with acromegaly without treatment showed that the quality of sleep decreased, the quality of life decreased, and the fatigue during the daytime increased[51]. Previous scholars reported that sleep efficiency was decreased in patients with the diagnosis of pituitary adenomas[52]. However, some researchers have different conclusions. In Previous scholars’ study, it was determined reported that sleep quality and sleepiness ratio did not change statistically in comparison with healthy controls[53]. Recently, more and more researchers pay attention to the sleep quality of patients with PA. However, the number of studies assessing HRQoL differs considerably between the different types of tumors, with the largest number of studies in patients with acromegaly, followed by Cushing’s disease and NFA, and the smallest number in patients with prolactinoma. This is in particular interesting, considering the fact, that prolactine hypersecretion is most common in pituitary adenomas[9].Future research should focus on HRQoL in this under-evaluated group. And the patients evaluated in this study were all types of PA, including functional and nonfunctional PA. In this study, we found that poor PA sleepers score worse both in the domains of the PCS and MCS of SF-36, which indicated that the quality of life of poor PA sleepers decreased in many aspects. These findings are in accordance with previous results about HRQoL in patients with PA as well as with results about the subjective sleep quality of individual patient groups, e. g of acromegaly[54], NFPAs[52], or cranio pharyngeomas[55]. It can be seen that sleep quality have physiological, social and psychological effects on individuals. We should pay more attention to the influence of sleep disorders on the quality of life among the patients with primary PA.
This paper reports the demographic, clinical, psychological characteristics, sleep quality and the influence of sleep quality on the quality of life of Chinese patients with primary PA: First, the questionnaires used in this study were all self-reported, which might result in possible biases of the outcomes. Second, this study is not a longitudinal study but a contrastive study. Though the conclusion from the data was not obtained, it contributed to the important problem by lowering HRQOL of the pituitary adenoma patient. Third, the primary PA patients were recruited from a single clinic of neurosurgery. In the future, studiers can expand the sample size from multiple centers and take effective intervention measures to improve the sleep quality in primary PA patients.