Brain Tumor Location, Grade Influence Sleep Disturbances After Treatment

A team of researchers analyzed clinical characteristics and sleep parameters in adult patients with primary brain tumors experiencing symptoms of sleep disturbance.

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Treatment of primary brain tumor (PBT) is associated with poor sleep quality in adults, with tumor location and grade being prominent factors that may influence the severity of sleep apnea after treatment, according to research intended to be presented at the 2021 American Academy of Neurology (AAN) 2021 Virtual Annual Meeting, held April 17 to 22, 2021.

This retrospective study included a chart review of adult patients with PBTs from a single center who experienced sleep disturbances. All patients were referred to a sleep center and underwent assessment by polysomnography. Besides having the patients complete the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, clinicians administered the STOP-Bang Questionnaire to screen for obstructive sleep apnea (OSA).

Most patients with PBTs had diffuse astrocytic and oligodendroglial tumors (69%) and tumors located in the cerebral cortex (71%). Approximately 18.5% had grade 1 tumors, 29.6% had grade 2 tumors, 25.9% had grade 3 tumors, and 25.9% had grade 4 tumors. Sleep disturbances were reported in 29% of patients prior to tumor diagnosis, while 93.5% of patients experienced sleep disturbances after tumor treatment.

A higher Karnofsky Performance Status, indicative of the patient’s ability to better perform daily activities, was associated with higher odds of normal sleep efficiency, but this was not statistically significant (P =.07).

Over 70% of patients referred to the institution’s sleep center had inadequate duration of nonREM and REM sleep. Patients with diffuse astrocytic tumors had a higher latency to REM sleep compared with patients with other histologies.

The primary variable associated with an apnea-hypopnea index of 15 or greater was the site of the tumor in a region other than the cerebral cortex. Central apneas were 49% more common compared with OSAs.

Compared with patients with grade 1 tumors, those with grade 4 tumors were associated with higher STOP-Bang scores, suggesting that tumor grade influenced sleep apnea incidence.

The study researchers noted that future prospective research should examine “clinical data and quantitative sleep parameters in larger patient cohorts to elucidate the sleep-tumor connection, interventions to improve sleep and ultimately improve” quality of life in patients with PBTs.


Soomro Z, Alfaro K, Balachandran D, et al. Primary brain tumor patients experience significant sleep disturbance; an analysis of clinical characteristics and sleep parameters. Presented at: the American Academy of Neurology 2021 Virtual Annual Meeting; April 17-22, 2021. Abstract P20.005