Prospective Rates, Longitudinal Associations, and Factors Associated With Comorbid Insomnia Symptoms and Perceived Cognitive Impairment.

Sheila N Garland,Hans Ivers,Josée Savard

doi:10.3389/fnins.2021.817933

Sheila N Garland, Hans Ivers + Show 1 more

Open Access

https://doi.org/10.3389/fnins.2021.817933

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Abstract

BackgroundInsomnia and cognitive impairment are both common conditions experienced by people diagnosed with cancer. Individually, these conditions have negative impacts on functioning, but the combined burden has yet to be evaluated. The purpose of this research was to estimate rates of comorbid insomnia and perceived cognitive impairments, examine the longitudinal associations between these two conditions, and identify demographic and clinical factors associated with reporting both insomnia and perceived cognitive impairment.MethodsIn this secondary analysis, a heterogeneous sample of 962 patients completed the Insomnia Severity Index (ISI) and the Cognitive Failures Questionnaire (CFQ) at the time of their cancer surgery (baseline; T1) and then again at 2 (T2), 6 (T3), 10 (T4), 14 (T5), and 18 (T6) months. Correlations and partial correlations, controlling for age and education level, were computed at each time point to assess the relationship between ISI and CFQ scores. Cross-lagged correlations assessed associations between ISI and CFQ scores over time. Proportions of patients with comorbid insomnia and cognitive impairments were calculated and logistic regressions investigated changes over time in these proportions. ANOVAs, logistic regressions, ordinal regressions, and multinomial regressions were used to identify risk factors of having comorbid insomnia and cognitive difficulties.ResultsSignificant and bidirectional correlations between ISI and CFQ scores were observed at each time point and over time. The proportion of patients having both clinical levels of insomnia and perceived cognitive difficulties ranged from 18.73 to 25.84% across time points and this proportion was significantly greater at T1 and T2 than T4, T5, and T6. Participants who reported comorbid insomnia and cognitive impairment were more likely to be younger, female, not currently working, currently receiving chemotherapy, with clinical levels depression and anxiety, and using antidepressants or anxiolytics.ConclusionComorbid insomnia and perceived cognitive impairment affects around one in five patients and is more frequent at the beginning of the cancer care trajectory. The relationship between insomnia and cognitive impairment appears to be bidirectional. Insomnia may represent an important patient level vulnerability that when identified and treated can improve perception of cognitive function.

Highlights

Insomnia is a prevalent and persistent condition in people diagnosed with cancer throughout their treatment trajectory (Palesh et al, 2010; Leysen et al, 2019)
Patients who experience insomnia at the time of their cancer diagnosis are significantly more likely to report persistent insomnia, compared to those who identify as good sleepers (Savard et al, 2011), which emphasizes the importance of early identification and intervention
They were excluded if they had received a neoadjuvant treatment for cancer, the surgery was part of brachytherapy for prostate cancer, had severe cognitive impairments (e.g., Alzheimer’s disease) or a severe psychiatric disorder, had received a diagnosis for a sleep disorder other than insomnia, and had severe visual, hearing or language defects

Summary

Introduction

Insomnia is a prevalent and persistent condition in people diagnosed with cancer throughout their treatment trajectory (Palesh et al, 2010; Leysen et al, 2019). Estimates suggest that roughly 40–60% of patients will present with insomnia symptoms and that around 20% will meet the criteria for a disorder at the time of diagnosis (Savard et al, 2011; Fleming et al, 2018; Harrold et al, 2020). Insomnia and cognitive impairment are both common conditions experienced by people diagnosed with cancer. These conditions have negative impacts on functioning, but the combined burden has yet to be evaluated. The purpose of this research was to estimate rates of comorbid insomnia and perceived cognitive impairments, examine the longitudinal associations between these two conditions, and identify demographic and clinical factors associated with reporting both insomnia and perceived cognitive impairment

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