Three-week actigraphy to assess sleep behaviour and circadian rest-activity patterns in suspected and confirmed Cushing’s syndrome: an exploratory prospective cohort study

Jun 16, 2026Pituitary

Three-week activity monitoring of sleep and daily rest-activity patterns in people with possible and confirmed Cushing's syndrome

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Abstract

Actigraphy detected a significantly earlier chronotype (p=0.022) in patients with confirmed Cushing's syndrome compared to those without.

Sleep efficiency, fragmentation, and circadian rest-activity rhythms were comparable in patients with confirmed Cushing's syndrome and those without.
Patients in remission exhibited similar sleep characteristics regardless of whether they had persistent or recovered adrenal insufficiency.
Late-night salivary cortisol levels displayed high variability among individuals and did not show consistent associations with sleep measures.
Higher late-night salivary cortisol was associated with earlier bedtimes, longer time in bed, prolonged sleep-onset latency, and reduced sleep efficiency in patients with persistent adrenal insufficiency.
Actigraphy demonstrated limited ability to differentiate between clinical groups in terms of sleep disturbances.

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PURPOSE: Sleep disturbances are common in endogenous Cushing's syndrome (CS), impair quality of life, and often persist despite remission. We evaluated the diagnostic value of actigraphy in suspected CS, characterised sleep and rest-activity patterns during remission, and examined associations between late-night salivary cortisol (LNSC) and objective sleep measures.

METHODS: Exploratory prospective single-centre cohort study at LMU Hospital Munich with two cohorts: (1) individuals evaluated for suspected CS and (2) patients in remission, stratified by recovered versus persistent adrenal insufficiency. Participants wore an ActTrust2 actigraph for 21 days, provided daily LNSC samples, and completed the Munich Chronotype Questionnaire.

RESULTS: Cohort 1 included 16 patients with confirmed CS and 13 with exclusion of CS. Actigraphy detected comparable sleep efficiency, fragmentation and circadian rest-activity rhythms in both groups, without distinct alterations attributable to active CS, except for a significantly earlier chronotype (p=0.022). Cohort 2 comprised 23 patients in remission (13 with persistent, 10 with recovered adrenal insufficiency) and showed similar sleep characteristics across subgroups. LNSC revealed high inter- and intraindividual variability without consistent associations with actigraphy-derived sleep parameters. Statistically significant effects were confined to patients with persistent adrenal insufficiency, in whom higher LNSC (likely reflecting non-physiological replacement therapy) was associated with earlier bedtime, longer time in bed, prolonged sleep-onset latency, and reduced sleep efficiency.

CONCLUSION: Apart from chronotype, actigraphy showed limited discriminatory value between clinical groups. LNSC was highly variable and showed no consistent associations with sleep parameters, underscoring the need for improved biomarkers and monitoring strategies in CS.

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Three-week actigraphy to assess sleep behaviour and circadian rest-activity patterns in suspected and confirmed Cushing’s syndrome: an exploratory prospective cohort study

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