Abstract
BackgroundSleep problems (SP) are common in cancer patients but have not been previously assessed in patients receiving immune checkpoint inhibitors (ICI).MethodsWe collected questionnaire data on sleep apnea risk, insomnia, and general sleep patterns. We used an adjusted multivariate Poisson regression to calculate prevalence ratios (PRs) and associated 95% confidence intervals (CIs) for associations between these SP and metastatic versus localized cancer stage (M1 vs. M0), and adjusted logistic regression models to calculate ORs for associations between SP with the number of ICI infusions completed (6 + vs. < 6).ResultsAmong 32 patients who received ICI treatment, the prevalence of low, intermediate, and high-risk OSA risk was 36%, 42%, and 21%, respectively. Overall, 58% of participants reported clinically significant insomnia. We did not find a significant association between intermediate or high risk OSA (vs. low risk) and metastatic cancer status (PR = 1.01 (95% CI: 0.28, 3.67)). Patients in the cohort who reported taking > 15 min to fall asleep were 3.6 times more likely to be diagnosed with metastatic cancer compared to those reporting shorter sleep latency (95% CI (1.74, 7.35)). We did not find a significant association between SP and number of ICI infusions completed.ConclusionOur data associating sleep apnea risk, insomnia, and sleep patterns with more advanced cancer encourages further exploration in larger-scale observational studies and suggests interventional clinical trials focused on sleep quality improvement that could result in better outcomes for these patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-022-06825-w.
Highlights
Sleep problems are a prominent concern of cancer patients
We report here outcomes from The Lifestyle Attributes and Sleep in Immunotherapy Response (LASIR) study describing the burden of sleep problems, its relation to the presence of metastases at diagnosis, and its impact on immune checkpoint inhibitors (ICI) tolerability in cancer patients previously unexposed to ICI therapy
The majority of patients had had cancer treatment prior to ICI initiation (64%), of whom 66.7% had surgery, 23.8% were treated with chemotherapy, and 19% with radiotherapy (Table 2)
Summary
Sleep problems are a prominent concern of cancer patients. Disturbed sleep is reported by 45–80% of cancer patients, compared to 29–32% of the general population [1]. Circadian disrupƟon (↓Melatonin) ModulaƟon of immune responses Sleep apnea induced IntermiƩent Hypoxia. Sleep problems (SP) are common in cancer patients but have not been previously assessed in patients receiving immune checkpoint inhibitors (ICI). Methods We collected questionnaire data on sleep apnea risk, insomnia, and general sleep patterns. Results Among 32 patients who received ICI treatment, the prevalence of low, intermediate, and high-risk OSA risk was 36%, 42%, and 21%, respectively. We did not find a significant association between intermediate or high risk OSA (vs low risk) and metastatic cancer status (PR = 1.01 (95% CI: 0.28, 3.67)). Conclusion Our data associating sleep apnea risk, insomnia, and sleep patterns with more advanced cancer encourages further exploration in larger-scale observational studies and suggests interventional clinical trials focused on sleep quality improvement that could result in better outcomes for these patients
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