Background
Disruptions in cognitive function have been described in the constellation of symptoms
associated with “asymptomatic” primary hyperparathyroidism (PHPT). The aim of this
study was to determine the impact of parathyroidectomy (PTX) on brain function and
sleep in “asymptomatic” PHPT patients.
Methods
We conducted a prospective, randomized trial comparing immediate PTX with observation
in patients with asymptomatic PHPT. We performed functional magnetic resonance imaging
(fMRI) of the brain, sleep assessment, and validated neuropsychological battery at
baseline, 6 weeks, and 6 months. Wilcoxon rank-sum and Pearson and Spearman correlations
were used.
Results
A total of 18 patients were randomized. Subjective sleepiness correlated with worse
performance on executive function tests during fMRI at 6 weeks (Pearson, −0.473; P = .047) and 6 months (Pearson, −0.673; P = .002). Total sleep time correlated with PTH levels at both 6 weeks (Pearson, 0.518;
P = .048) and 6 months (Pearson, 0.567; P = .018). At 6 weeks, hypersomnolence as measured subjectively was decreased in the
PTX group, but increased in those observed (−2.56 vs 2.22; P = .03)
Conclusion
This prospective, randomized trial for asymptomatic PHPT patients demonstrated an
association of sleep with brain function. Sleep seemed to be an indicator of brain
activation in the anterior cingulate gyrus and precentral cortex. Subjective sleepiness
was associated with executive function. The results of this pilot study suggest that
decreased serum PTH levels correlate with improved sleep and that PTX decreases sleepiness
in patients with asymptomatic PHPT.
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Article info
Publication history
Published online: November 02, 2009
Accepted:
September 25,
2009
Footnotes
Funded by the American Geriatric Society, Jahnigan Career Development Award
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
