Medical History of Optic Chiasm Compression in Patients With Pituitary Insufficiency Affects Skin Temperature and Its Relation to Sleep

Abstract

The hypothalamus is crucially involved in the circadian timing of the sleep-wake rhythm, yet also accommodates the most important thermoregulatory neuronal network. We have shown before that adults with pituitary insufficiency and history of chiasm compression due to a tumor with suprasellar extension fall asleep later and sleep shorter than those without such history and presumed hypothalamic involvement. To solidify the hypothesized link between vigilance and thermoregulation by the hypothalamus, we aimed to test the hypothesis that the presumed hypothalamic impairment in these patients also affects skin temperature and its association with sleep onset. In a case-control study of 50 patients (54.7 ± 14.5 yrs of age, 30 males) with pituitary insufficiency, 33 of whom had a history of chiasm compression, ambulatory distal and proximal skin temperatures were assessed continuously for 24 h. Sleep parameters were assessed via questionnaire. Group differences in mean skin temperature, calculated over the wake and sleep periods separately, and group differences in the strength of association between pre-sleep skin temperature and sleep onset latency were compared. Results showed that patients with a medical history of chiasm compression had lower proximal skin temperature during the day (34.1°C ± .7°C vs. 34.6°C ± .7°C, p = .045). Additionally, the typical association between sleep onset latency and pre-sleep distal-to-proximal skin temperature gradient was absent in these patients (r = −.01, p = .96), whereas it was unimpaired in those without chiasm compression (r = −.61, p = .02). Thus, patients with history of chiasm compression show impaired skin temperature regulation in association with disturbed sleep. The findings support the hypothesis that a medical history of chiasm compression affects hypothalamic regulation of both vigilance and temperature, possibly by chronically affecting relevant nuclei, including the ventrolateral preoptic area and anterior hypothalamic preoptic area. (Corresponding Author: [email protected])

Keywords:

• Hypopituitarism
• Hypothalamus
• Optic chiasm
• Skin temperature
• Sleep

ACKNOWLEDGMENTS

The authors wish to acknowledge Mrs. Martine van Vessem-Timmermans for her excellent technical assistance and care of the patients during the study.

Declaration of Interest: This work was supported by Project NeuroSIPE 10738, of the Dutch Technology Foundation STW, which is part of the Netherlands Organization for Scientific Research (NWO) and partly funded by the Ministry of Economic Affairs, Agriculture and Innovation; and by the VICI Innovation Grant 453-07-001 of the Netherlands Organization of Scientific Research (NWO), The Hague; and by a Veni-grant of The Netherlands Organization for Health Research and Development (No. 916.86.020 to A.A.).

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.