SAT-425 - Sleep Recovery Following Surgical Remission of Endogenous Hypercortisolism: A Prospective Cohort Study.

Context
Sleep disturbance is a prevalent and clinically meaningful manifestation of endogenous hypercortisolism, yet its trajectory following curative treatment remains poorly characterized.

Objective
To characterize changes in sleep quality after surgical treatment of endogenous hypercortisolism and identify predictors of clinically meaningful sleep improvement.

Design, Setting, and Participants
Prospective longitudinal cohort study (PROMISE sub study), including patients with mild autonomous cortisol secretion (MACS) and Cushing syndrome (CS) undergoing surgery.

Main Outcomes and Measures
Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Clinically meaningful improvement was defined as a ≥3-point reduction. Multivariable logistic regression was used to identify baseline factors associated with sleep improvement.

Results
The cohort included 214 patients with MACS (159, 74% women) and 162 with CS (143, 88% women). Patients with CS were younger (median age 47 vs 59 years) and had greater clinical (median 16 [IQR 12–18] vs 8 [4–12]) and biochemical severity scores (median 6.5 [5–8] vs 3 [2–4]) compared to patients with MACS (all P< 0.001).

Sleep quality improved significantly following surgery in both groups, with greater magnitude of improvement in CS. In CS, PSQI decreased by a median of −2 points (IQR −5 to 1; P< 0.001) at 3 months and −3 points (IQR −7 to 0; P< 0.01) at 12 months. In MACS, improvements were more modest (−1 [IQR −4 to 1; P< 0.001] at 3 months and −1 [IQR −4 to 0; P=0.002] at 12 months).

In multivariable analysis, higher baseline PSQI (odds ratio [OR] 1.29 per point; 95% CI 1.17–1.44) and greater biochemical severity (OR 1.26 per point; 95% CI 1.07–1.51) were associated with a clinically meaningful improvement, whereas age, sex, BMI, and postoperative glucocorticoid therapy (hydrocortisone versus prednisone) were not associated.

Conclusions
Surgical treatment of endogenous hypercortisolism is associated with significant improvement in sleep quality. Greater baseline sleep impairment and biochemical severity identify patients most likely to benefit, supporting sleep as a meaningful, patient-centered outcome of treatment.

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