Relationship between Sleep Stage IV Deficit and Reversible HGH Deficiency in Psychosocial Dwarfism

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Abstract
Summary: Polygraphic sleep recordings were done in four children with psychosocial dwarfism. The first recordings, performed within the first days after hospitalization, exhibited a gross deficit of stage IV sleep and a decrease of the durations of slow wave sleep episodes (SWS = stages III and IV). The second recordings were performed after several wk (3–15) in the new environment, during the growth recovery period. A clear improvement of sleep quality was observed, namely an increase of stage IV amounts. In two of the four patients, hGH release was studied by means of the ornithine test. A low response was found in the first (2) days of hospitalization whereas a normal response was observed during the recovery period suggesting a partial and reversible hGH deficiency. A simultaneous recovery of both stage IV sleep and the growth rate was observed in the four patients. These data suggest that sleep disturbances are strongly linked to growth failure in psychosocial dwarfism. Speculation: A reversible hGH deficit has been found in psychosocial dwarfism. A temporal relationship between nocturnal release of hGH and slow wave sleep has already been established by others. We hypothesize that the slow wave sleep deficit observed in our patients can induce a deprivation of considerable amounts of hGH. At this point it is not possible to say whether the functional deficit of hGH is a consequence of the lack of stage IV, a reduction of the duration of slow wave sleep (stages 111 and IV) episodes, or both.