Sleep quality in hospitalized patients with advanced cancer: an observational study using self-reports of sleep and actigraphy.

Abstract

Although patients with advanced cancer report poor sleep quality, few studies have assessed sleep quality with a combination of subjective and objective measures. We aimed to examine sleep quality in hospitalized patients with advanced cancer by combining patient-reported outcome-measures (PROMs) and polysomnography (PSG) or actigraphy. A one-night prospective observational study of sleep in hospitalized patients with metastatic cancer using WHO step III opioids was conducted. Total sleep time, sleep onset latency, number of awakenings, and wake after sleep onset were assessed by PROMs and actigraphy. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) (range; 0-21), where higher scores indicate worse sleep quality. Forty patients were monitored. Median age was 70, median oral morphine equivalent dose was 80mg/24h (10-1725), median Karnofsky Performance Score was 50 (20-90), and median time to death from inclusion was 38days (4-319). Mean PSQI score was 6.5 (SD ± 3.4). PROMs and actigraphy of mean (SD) sleep onset latency were 46 (± 64) and 35min (± 61), respectively, while mean time awake at night was 37 (± 35) and 40min (± 21). PROMs and actigraphy differed on number of awakenings (mean 2 (± 1) vs. 24 (± 15), p˂0.001). Bland-Altman plots showed large individual differences between PROMs and actigraphy. PSG was not feasible. PROMs and actigraphy documented poor sleep quality, but a lack of agreement across methods. The study demonstrates a need to improve assessment of sleep quality and treatment of sleep disturbance in hospitalized patients with advanced cancer near end of life.