However, delta and theta activities were markedly higher in GHD patients than in controls. On average, the global PSQI was indicative of poor sleep i. The component assessing daytime sleepiness was also elevated in these patients compared with their controls 1. No significant correlations were found between the global PSQI score and polysomnography-derived sleep variables.
Group data for QoL variables for the 26 patients with primary pituitary lesions and their matched controls are given in Table 2. QoL scores were similar in U. Tiredness was the most frequent complaint and reached the highest score in both age groups. Memory problems were also more frequent in GHD patients than controls. Figure 1 bottom panels illustrates the differences between GHD patients and controls for the five domains of QoL and the two age groups.
When each age group was analyzed separately, tiredness was the only domain significantly affected in young patients, whereas in older patients, deficits in memory and concentration and a trend for more social problems were also found. No other correlations between sleep variables and global or partial QoL scores were found. As in Fig. Note differences of scales in the different categories. Differences in levels of delta activity across the four control groups are due to differences in sex, age, and BMI distribution.
For each diagnostic category, patients and controls are pair matched for sex, age, and BMI. Irrespective of GHD etiology i. Indeed, as illustrated in Fig. The present study, performed in a large group of adult GHD patients individually matched for gender, age, and BMI with control subjects, indicates that GHD due to a confirmed or likely primary pituitary defect is associated with an excess of high intensity SWS, poor subjective sleep quality, and daytime sleepiness. Excessive amounts of SWS which were also observed in night 1, i.
The enhancement of EEG power was specific to the delta and theta ranges as alpha power was similar in patients and controls. One possible mechanism underlying this enhancement of SWS and delta activity could be an exaggeration of the well-documented stimulatory effect of GHRH on delta activity resulting from a lack of negative feedback regulation of GHRH by circulating GH. Consistent with this putative mechanism, up-regulation of hypothalamic GHRH activity, due to the absence of inhibitory control by GH, associated with increased amounts of NREM sleep has indeed been demonstrated in an animal model of GHD, the spontaneous dwarf rat 25 , A reduction in the inhibitory control of hypothalamic GHRH by GH might contribute to an incomplete inhibition of SWS-generating mechanisms during wake as well as during sleep and result in daytime sleepiness.
Among our younger patients, those with higher amounts of SWS tended to have higher tiredness scores. Although these associations do not indicate causality, they suggest that sleep disturbances may contribute to daytime sleepiness and tiredness complaints. This loss of REM sleep, possibly due to GHD 5 , 6 , 11 , 12 , could be involved in the emergence of memory problems, which were reported more frequently by older patients than their controls.
There is indeed a growing body of evidence linking REM sleep and memory 27 , Older adults with pituitary GHD also had more sleep fragmentation in the later part of the night and obtained less total sleep time than control subjects. Whereas increased number and duration of awakenings, decreased total sleep time, and decreased amounts of REM sleep are typical of normal adults in late life 24 , pituitary GHD appears associated with an exacerbation of these sleep disturbances, suggestive of a more rapid senescence of sleep-regulating mechanisms in the absence of GH.
The combination of increased duration and intensity of SWS in the early part of the night with increased sleep fragmentation in the later part of the night represents a peculiar sleep disorder as higher levels of SWS are generally associated with more consolidated sleep. In remarkable contrast to findings in the two groups of patients in whom there was no evidence for a suprapituitary involvement in the etiology of GHD i.
Although these limited results await confirmation in a larger group of patients, they are consistent with a central role of GHRH activity in modulating sleep quality in GHD. Findings in patients with pituitary defects and possible hypothalamic involvement were intermediate, consistent with a mixed etiology of GHD.
Our findings are at variance with those reported nearly 20 yr ago in eight subjects with isolated GHD In this latter study, controls were matched for sex and age but not for BMI.
Bedtimes and sleep periods were not reported, activity during waking hours was not controlled, and daytime naps were not prohibited. Total sleep time was surprisingly long in patients, ranging from 7 h 45 min to 11 h 44 min with a median of nearly 9 h.
Extended bedtimes and naps generally result in a shift of NREM sleep toward lighter stages 29 , which could explain the discrepancy with our findings. In a separate study, sleep profiles in a group of patients with adult-onset GHD were reported to be comparable with a nonspecified and nonindividually matched healthy control group from the literature Because of the high variability, especially with gender and age, of sleep characteristics among normal individuals, this study design was unlikely to detect differences between GHD patients and controls.
Although an impact of hormonal deficits and their treatment on sleep quality cannot be excluded, the fact that younger and older patients were similarly treated and sleep was nonetheless more disturbed in older patients does not support a primary role of replacement therapy in the sleep disorders.
In conclusion, the present findings suggest that GHD may be associated with major sleep alterations and that tiredness, a major QoL complaint in GHD, may reflect poor sleep quality and daytime sleepiness. The sleep phenotype of GHD may be dependent on its etiology. Thanks are due to Claire van den Bril, M. We are grateful to Dr. Penev for assistance with the screening of subjects recruited at the University of Chicago and Dr.
Barbara Lippe formerly of Pharmacia Corp. This work was supported by an investigator-initiated grant from Pharmacia Corp. During part of the study, A. J Clin Endocrinol Metab 88 : — Google Scholar. Totowa, NJ : Humana Press. Google Preview. Sleep 21 : — Sleep Med Rev 8 : — Am J Physiol : R — R Am J Physiol : E — E Sleep 14 : 87 — Neuroendocrinology 56 : — J Clin Endocrinol Metab 81 : — Biol Psychiatry 15 : — Evaluated by manual polysomnography and automatic power spectrum analysis.
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Percept Mot Skills 85 : — Eur J Endocrinol : — Rechtschaffen A , Kales A A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Sleep 28 : — HGH should be used with care and consideration. Take special care to note how your body reacts and if you experience any adverse reactions. Eat a healthy diet, exercise regularly, and engage in healthy habits to improve your overall health and well-being.
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Here are the 6 best supplements to gain more muscle. Wide feet are usually nothing to worry about, although they can sometimes be caused by other health issues. Treating these conditions and wearing….
Learn about possible causes and treatments. The test can take several…. Growth hormone tests measure the amount of growth hormone in your blood. Growth hormone plays a crucial role in human development. Health conditions…. Health Conditions Discover Plan Connect.
Medically reviewed by Lindsay Slowiczek, Pharm. Uses and benefits. Popular forms. In adults, a lack of HGH can cause a number of different problems including :. These include :. The most common treatment in both adults and children is growth hormone therapy using lab-developed HGH injections.
Doses occur several times per week or on a daily basis depending on how severe the deficiency is. Manufacturers designed the growth hormone to mimic the behavior of natural growth hormone in the body. It will be prescribed by a doctor. HGH treatments can be self-administered or given by a doctor.
Treatments are often given for several years. Patients will see their doctor every month or so to check their condition. Blood tests will be carried out to see if extra growth hormone is needed and if treatments should be increased, decreased, or stopped.
Cholesterol levels, blood sugar levels, and bone density will also be checked to see if they are healthy. Growth hormone deficiency can also lead to high cholesterol and brittle bones if it is not treated. The earlier the lack of growth hormone is treated in children, the better chance they have to grow to a near normal adult height. Children can gain as many as 4 inches or more over the first 3 years of treatment.
Another 3 inches or more can grow during the next 2 years. Anyone taking HGH will undergo regular monitoring to assess the safety and effectiveness of the hormone. The goal of growth hormone treatments in adults and children is to restore energy, metabolism, and enhance body development or shape. It can help to reduce total body fat, especially around the belly. HGH injections can also help to improve strength and exercise tolerance and reduce the risk of heart disease in those who lack growth hormone.
Many people experience an increase in overall quality of life. Most people tolerate HGH injection treatments well with few problems. Those who experience these symptoms or other problems should talk to their doctor. They can change the dose if necessary to help remedy the symptoms. HGH injections are not recommended for people who have:. HGH can affect insulin usage in the body, so people with diabetes should monitor their blood sugar levels carefully.
Surgery or radiation may be necessary to treat a tumor in the pituitary. Pituitary hormones may also have to be taken to correct a gland that is not working properly. If the levels of HGH are too high in adults, they may experience:.
Long-term use of HGH injections can cause a condition called acromegaly. Adults cannot grow taller by using the synthetic growth hormone. People with acromegaly will experience an overgrowth of bones, particularly in the hands, feet, and face. The skin area can also be affected and may turn thick, coarse, and hairy. The excess HGH levels can also lead to high blood pressure and heart disease. HGH injections have also become popular for nonmedical usage.
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