Compression of the optic chiasm is associated with reduced photoentrainment of the central biological clock

in European Journal of Endocrinology
Authors:
Tessel M BoertienAmsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands

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https://orcid.org/0000-0002-1285-4834
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Eus J W Van SomerenNetherlands Institute for Neuroscience (NIN), Sleep and Cognition, Amsterdam, The Netherlands
Amsterdam UMC location VU University, Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep, Amsterdam, The Netherlands
VU University, Centre for Neurogenomics and Cognitive Research, Integrative Neurophysiology, Amsterdam, The Netherlands

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Adriaan D CoumouAmsterdam UMC location University of Amsterdam, Ophthalmology, Amsterdam, The Netherlands

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Annemieke K van den BroekAmsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands

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Jet H KlunderAmsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands

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Wing-Yi WongAmsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands

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Adrienne E van der HoevenAmsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands

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Madeleine L DrentAmsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands
Amsterdam UMC location VU University, Internal Medicine, Section of Endocrinology, Amsterdam, The Netherlands

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Johannes A RomijnAmsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
Amsterdam UMC location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands

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Eric FliersAmsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands

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Peter H BisschopAmsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands

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Correspondence should be addressed to T M Boertien; Email: t.m.boertien@amsterdamumc.nl
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Objective

Pituitary tumours that compress the optic chiasm are associated with long-term alterations in sleep–wake rhythm. This may result from damage to intrinsically photosensitive retinal ganglion cells (ipRGCs) projecting from the retina to the hypothalamic suprachiasmatic nucleus via the optic chiasm to ensure photoentrainment (i.e. synchronisation to the 24-h solar cycle through light). To test this hypothesis, we compared the post-illumination pupil response (PIPR), a direct indicator of ipRGC function, between hypopituitarism patients with and without a history of optic chiasm compression.

Design

Observational study, comparing two predefined groups.

Methods

We studied 49 patients with adequately substituted hypopituitarism: 25 patients with previous optic chiasm compression causing visual disturbances (CC+ group) and 24 patients without (CC– group). The PIPR was assessed by chromatic pupillometry and expressed as the relative change between baseline and post-blue-light stimulus pupil diameter. Objective and subjective sleep parameters were obtained using polysomnography, actigraphy, and questionnaires.

Results

Post-blue-light stimulus pupillary constriction was less sustained in CC+ patients compared with CC– patients, resulting in a significantly smaller extended PIPR (mean difference: 8.1%, 95% CI: 2.2–13.9%, P = 0.008, Cohen’s d = 0.78). Sleep–wake timing was consistently later in CC+ patients, without differences in sleep duration, efficiency, or other rest–activity rhythm features. Subjective sleep did not differ between groups.

Conclusion

Previous optic chiasm compression due to a pituitary tumour in patients with hypopituitarism is associated with an attenuated PIPR and delayed sleep timing. Together, these data suggest that ipRGC function and consequently photoentrainment of the central biological clock is impaired in patients with a history of optic chiasm compression.

Supplementary Materials

 

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     European Society of Endocrinology

Sept 2018 onwards Past Year Past 30 Days
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