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World Journal of Surgery

Published in:

01-03-2014

Improvement of Sleep Disturbance and Insomnia Following Parathyroidectomy for Primary Hyperparathyroidism

Authors: Sara E. Murray, Priya R. Pathak, Sarah C. Schaefer, Herbert Chen, Rebecca S. Sippel

Published in: World Journal of Surgery | Issue 3/2014

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.

Health H III (1991) Clinical spectrum of primary hyperparathyroidism: evolution with changes in medical practices and technology. J Bone Miner Res 6:S63–S70CrossRef

Bilezikian JP, Silverberg SJ, Gartenberg F et al (1994) Clinical presentation of primary hyperparathyroidism. In: Bilezikian JP (ed) The parathyroids: basic and clinical concepts. Raven Press, New York, pp 457–470

Silverberg SJ, Lewiecki EM, Mosekilde L et al (2009) Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94:351–365PubMedCrossRef

Eigelberger MS, Cheah WK, Ituarte PHG et al (2004) The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism. Are they too limited? Ann Surg 239:528–535PubMedCrossRef

Pasieka JL, Parsons LL (1998) Prospective surgical outcome study of relief of symptoms following surgery in patients with primary hyperparathyroidism. World J Surg 22:513–518. doi: 10.1007/s002689900428 PubMedCrossRef

Pasieka JL, Parsons LL, Demeure MJ et al (2002) Patient-based surgical outcome tool demonstrating alleviation of symptoms following parathyroidectomy in patients with primary hyperparathyroidism. World J Surg 26:942–949. doi:10.1007/s00268-002-6623-y PubMedCrossRef

Caillard C, Sebag F, Mathonnet M et al (2007) Prospective evaluation of quality of life (SF-36v2) and nonspecific symptoms before and after cure of primary hyperparathyroidism (1-year follow-up). Surgery 141:153–160PubMedCrossRef

Sywak MS, Knowlton ST, Pasieka JL et al (2002) Do the National Institutes of Health consensus guidelines for parathyroidectomy predict symptom severity and surgical outcome in patients with primary hyperparathyroidism? Surgery 132:1013–1020PubMedCrossRef

Gopinath P, Sadler GP, Mihai R (2010) Persistent symptomatic improvement in the majority of patients undergoing parathyroidectomy for primary hyperparathyroidism. Langenbecks Arch Surg 395:941–946PubMedCrossRef

10.

Okamoto T, Kamo T, Obara T (2002) Outcome study of psychological distress and nonspecific symptoms in patients with mild primary hyperparathyroidism. Arch Surg 137:779–783PubMedCrossRef

11.

Joborn C, Hetta J, Johansson H et al (1988) Psychiatric morbidity in primary hyperparathyroidism. World J Surg 12:476–481. doi:10.1007/BF01655425 PubMedCrossRef

12.

Joborn C, Hetta J, Lind L et al (1989) Self-rated psychiatric symptoms in patients operated on because of primary hyperparathyroidism and in patients with long-standing mild hypercalcemia. Surgery 105:72–78PubMed

13.

Numann PJ, Torppa AJ, Blumetti AE (1984) Neuropsychologic deficits with primary hyperparathyroidism. Surgery 96:1119–1123PubMed

14.

McAllion SJ, Paterson CR (1989) Psychiatric morbidity in primary hyperparathyroidism. Postgrad Med J 65:628–631PubMedCrossRef

15.

Tsukahara K, Sugitani I, Fujimoto Y et al (2008) Surgery did not improve the subjective neuropsychological symptoms of patients with incidentally detected mild primary hyperparathyroidism. Eur Arch Otorhinolaryngol 265:565–569PubMedCentralPubMedCrossRef

16.

Repplinger D, Schaefer S, Chen H et al (2009) Neurocognitive dysfunction: a predictor of parathyroid hyperplasia. Surgery 146:1138–1143PubMedCrossRef

17.

Bargen AE, Repplinger D, Chen H et al (2011) Can biochemical abnormalities predict symptomatology in patients with primary hyperparathyroidism? J Am Coll Surg 213:410–414CrossRef

18.

Murray SE, Pathak PR, Pontes DS, et al (2013) Timing of symptom improvement after parathyroidectomy for primary hyperparathyroidism. Abstract presented at American Association of Endocrine Surgery Annual Meeting Chicago, IL

19.

Adler JT, Sippel RS, Schaefer S et al (2009) Surgery improves quality of life in patients with “mild” hyperparathyroidism. Am J Surg 197:284–290PubMedCrossRef

20.

Burney RE, Jones KR, Coon JW et al (1996) Assessment of patient outcomes after operation for primary hyperparathyroidism. Surgery 120:1013–1019PubMedCrossRef

21.

Burney RE, Jones KR, Peterson M et al (1998) Surgical correction of primary hyperparathyroidism improves quality of life. Surgery 124:987–999PubMedCrossRef

22.

Talpos GB, Bone HG, Kleerekoper M et al (2000) Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism: patient description and effects on the SF-36 health survey. Surgery 128:1013–1020PubMedCrossRef

23.

Conference NIH (1991) Diagnosis and management of asymptomatic primary hyperparathyroidism: consensus development conference statement. Ann Intern Med 114:593–597CrossRef

24.

Bilezikian JP, Potts JT Jr, Gel-H Fuleihan et al (2002) Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab 87:5353–5361PubMedCrossRef

25.

Mittendorf EA, Wefel JS, Meyers CA et al (2007) Improvement of sleep disturbance and neurocognitive function after parathyroidectomy in patients with primary hyperparathyroidism. Endocr Pract 13:338–344PubMedCrossRef

26.

Ishak ww, Bagot K, Thomas S et al (2012) Quality of life in patients suffering from insomnia. Innov Clin Neurosci 9:13–26PubMedCentralPubMed

27.

Perrier ND, Coker LH, Rorie KD et al (2006) Preliminary report: functional MRI of the brain may be the ideal tool for evaluating neuropsychologic and sleep complaints of patients with primary hyperparathyroidism. World J Surg 30:686–696. doi:10.1007/s00268-005-0361-x PubMedCrossRef

28.

Perrier ND, Balachandran D, Wefel JS et al (2009) Prospective, randomized, controlled trial of parathyroidectomy versus observation in patients with “asymptomatic” primary hyperparathyroidism. Surgery 146:1116–1122PubMedCrossRef

29.

Bastien CH, Vallières A, Morin CM (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2:297–307PubMedCrossRef

30.

Savard MH, Savard J, Simard S et al (2005) Empirical validation of the Insomnia Severity Index in cancer patients. Psychooncology 14:429–441PubMedCrossRef

31.

Morin CM, Belleville G, Belanger L et al (2011) The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34:601–608PubMed

32.

Smith S, Trinder J (2001) Detecting insomnia: comparison of four self-report measures of sleep in a young adult population. J Sleep Res 10:229–235PubMedCrossRef

33.

Ohayon MM (2002) Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 6:97–111PubMedCrossRef

34.

Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMed

35.

Reiher AE, Mazeh H, Schaefer S et al (2012) Symptoms of gastroesophageal reflux disease improve after parathyroidectomy. Surgery 152:1232–1237PubMedCrossRef

36.

Nilsson IL, Aberg J, Rastad J et al (2003) Circadian cardiac autonomic nerve dysfunction in primary hyperparathyroidism improves after parathyroidectomy. Surgery 134:1013–1019PubMedCrossRef

37.

Safley SA, Villinger F, Jackson EH et al (2004) Interleukin-6 production and secretion by human parathyroids. Clin Exp Immunol 136:145–156PubMedCentralPubMedCrossRef

38.

Opp MR (2005) Cytokines and sleep. Sleep Med Rev 9:355–364PubMedCrossRef

Title: Improvement of Sleep Disturbance and Insomnia Following Parathyroidectomy for Primary Hyperparathyroidism
Authors: Sara E. Murray
Priya R. Pathak
Sarah C. Schaefer
Herbert Chen
Rebecca S. Sippel
Publication date: 01-03-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 3/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-2285-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Improvement of Sleep Disturbance and Insomnia Following Parathyroidectomy for Primary Hyperparathyroidism

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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