Short sleep duration and physical and psychological health outcomes among adult survivors of childhood cancer.

Abstract

To examine associations between phenotypes of short sleep duration and clinically assessed health conditions in long-term survivors of childhood cancer. Survivorsrecruited from the St. Jude Lifetime Cohort(n=911;52% female;mean age34 years; 26 years postdiagnosis)completedbehavioral health surveysand underwent comprehensive physical examinations. Sleep was assessed with the Pittsburgh Sleep Quality Index. Short sleep was defined as ≤6h per night with phenotypes of short sleep including poor sleep efficiency (<85%), prolonged sleep onset latency (SOL; ≥30 min), and wake after sleep onset (≥3 times per week). Covariates includedchildhood cancertreatment exposures,demographics,body mass index, andphysicalinactivity.Separatemodified Poisson regression modelswere computed foreach healthcategoryto estimaterelative risks (RR)and 95% confidence intervals (CI).Multinomial logistic regression models examined associations between sleep and an aggregated burden of chronic health conditions. Short sleep duration was reported among 44% (95% CI 41%-47%) of survivors. In multivariable models, short sleep duration alone was associated with pulmonary (RR=1.35, 95% CI 1.08-1.69), endocrine (RR=1.22, 95% CI 1.06-1.39) and gastrointestinal/hepatic conditions (RR=1.46, 95% CI 1.18-1.79), and anxiety (RR 3.24, 95% CI 1.64-6.41) and depression (RR=2.33, 95% CI 1.27-4.27). Short sleep with prolonged SOL was associated with a high/severe burden of health conditions (OR=2.35, 95% CI 1.12-4.94). Short sleep duration was associated with multiple clinically ascertained adverse health conditions. Although the temporality of these associations cannot be determined in this cross-sectional study, sleep is modifiable and improving sleep may improve long-term health in survivors.