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Neuroendocrinology and Pituitary

MON-028 - Sleep, Circadian Rhythm, and Quality of Life in Cushing Disease: A Pilot Study

Monday, June 15, 2026
9:00 AM - 2:00 PM CT


Introduction: Cushing’s disease (CD) is a rare endocrine disorder resulting in unregulated elevated cortisol secretion, severe metabolic complications, and several health comorbidities. Approximately 70% of patients with CD report sleep problems, which may be among the first signs of disease onset. In other populations, both sleep and circadian rhythm disruption, as measured by non-invasive, movement-based activity monitoring (actigraphy; ACT), are associated with reduced quality of life (QOL), but they are rarely considered in the assessment and treatment of CD. Therefore, this pilot project is the first to examine how ACT assessment of sleep, daytime activity, and rest-activity patterns relate to self-reported QOL among individuals with untreated CD before and after CD-tumor-removal surgery.

Methods: Seven participants with confirmed CD completed their pre-surgery ACT collection (mean age= 33.4 yrs [22-45]; 86% female), during which they wore a wrist actigraph for 5-14 days. Participants completed the Cushing’s-QOL scale. Sleep was characterized by onset latency, total sleep time, sleep efficiency (% time asleep/time in bed), wake time after falling asleep, and fragmentation of sleep. Interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA) were also calculated to characterize circadian rhythms. Analyses were done using Spearman correlations.

Results: Participants with lower sleep efficiency, more time awake after falling asleep, and more fragmented sleep reported worse QOL on the Cushing’s-QOL scale. QOL was not related to indies of circadian rhythm in this sample.

Discussion: These results provide initial data that sleep health is related to QOL in CD. Longitudinal data collection is ongoing to determine if sleep health is related to remission status in the months following surgical treatment. Sleep and circadian rhythm are a sensitive predictor of health outcomes and mortality in other populations and may be a sign of early disease onset, progression, remission, and/or occurrence in CD.

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