Sleep disturbances in craniopharyngioma: a systematic review and meta-analysis

Craniopharyngioma is a rare, parasellar tumor of low histological malignancy (WHO grade 1) arising from remnants of the Rathke pouch, which can disrupt hypothalamic modulation. Sleep disturbances, including excessive daytime sleepiness (EDS), are commonly reported in patients with craniopharyngioma, although findings have been inconsistent. This systematic review and meta-analysis was conducted to aggregate prior sleep-related findings in craniopharyngioma patients, with the aim of determining the prevalence and severity of sleep disorders, as well as quantifying alterations in sleep structure and sleep breathing.

Databases including PubMed, Web of Science, EBSCO, and Cochrane library were searched up through April 8, 2025, to identify studies investigating sleep disturbances in craniopharyngioma patients. Random-effect meta-analysis was employed to calculate the pooled proportion of patients with sleep disorders, pooled means of sleep scale and polysomnography parameters, and the standard mean difference in sleep parameters between craniopharyngioma patients and control group.

A total of 22 studies, encompassing 1137 patients and 370 matched controls, were included. The meta-analysis revealed that the pooled mean score of Pittsburgh sleep quality index in craniopharyngioma patients was 6.76 (95% CI: 6.17-7.35). The overall prevalence of EDS was 50% (95% CI: 40%-61%), with a higher estimate from the multiple sleep latency test (MSLT) (55%, 95% CI: 43%-67%) and a lower estimate from Epworth sleepiness scale (ESS) (36%, 95% CI: 25%-48%). The prevalence of narcolepsy and obstructive sleep apnea were 27% (95% CI: 21%-33%) and 14% (95% CI: 5%-24%), respectively. The periodic limb movements index was obviously abnormal across age subgroups in craniopharyngioma. Compared to healthy controls, patients with craniopharyngioma exhibited significantly reduced rapid eye movement sleep; and compared to obese controls, craniopharyngioma patients showed shorter sleep onset latency but no reduction in non-rapid eye movement stage 3. Additionally, the pooled mean sleep latency for patients with craniopharyngioma on the MSLT was 8.45 min, significantly shorter than in healthy and obese controls.

Our findings imply sleep-related impairments in patients with craniopharyngioma during both of diurnal and nocturnal phases, particularly the daytime hypersomnolence and narcolepsy. Discrepancies between subjective ESS and objective MSLT of EDS assessments underscore the need for the MSLT in pediatric patients. These results suggest that the tumor and/or its treatment may affect the coordination of hypothalamic sleep-wake regulatory nuclei or orexin neurons.