Abstract
BackgroundMany cancer patients report poor sleep quality, despite having adequate time and opportunity for sleep. Satisfying sleep is dependent on a healthy circadian time structure and the circadian patterns among cancer patients are quite abnormal. Wrist actigraphy has been validated with concurrent polysomnography as a reliable tool to objectively measure many standard sleep parameters, as well as daily activity. Actigraphic and subjective sleep data are in agreement when determining activity-sleep patterns and sleep quality/quantity, each of which are severely affected in cancer patients. We investigated the relationship between actigraphic measurement of circadian organization and self-reported subjective sleep quality among patients with advanced lung cancer.MethodsThis cross-sectional and case control study was conducted in 84 patients with advanced non-small cell lung cancer in a hospital setting for the patients at Midwestern Regional Medical Center (MRMC), Zion, IL, USA and home setting for the patients at WJB Dorn Veterans Affairs Medical Center (VAMC), Columbia, SC, USA. Prior to chemotherapy treatment, each patient's sleep-activity cycle was measured by actigraphy over a 4-7 day period and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire.ResultsThe mean age of our patients was 62 years. 65 patients were males while 19 were females. 31 patients had failed prior treatment while 52 were newly diagnosed. Actigraphy and PSQI scores showed significantly disturbed daily sleep-activity cycles and poorer sleep quality in lung cancer patients compared to healthy controls. Nearly all actigraphic parameters strongly correlated with PSQI self-reported sleep quality of inpatients and outpatients.ConclusionsThe correlation of daily activity/sleep time with PSQI-documented sleep indicates that actigraphy can be used as an objective tool and/or to complement subjective assessments of sleep quality in patients with advanced lung cancer. These results suggest that improvements to circadian function may also improve sleep quality.
Highlights
Many cancer patients report poor sleep quality, despite having adequate time and opportunity for sleep
For the Midwestern Regional Medical Center (MRMC) patients, actigraphy was performed at the inpatient setting before and during their first chemotherapy cycle, while for the Veterans Affairs Medical Center (VAMC) patients, actigraphy data were obtained in the outpatient/home setting prior to the initiation of chemotherapy
Out of the 72 patients with complete actigraph recordings, four patients failed to respond to the Pittsburgh Sleep Quality Index (PSQI) questionnaire, so we have complete actigraphy and questionnaire data for 68 (35 inpatients, 33 outpatients) of the 84 enrolled patients
Summary
Many cancer patients report poor sleep quality, despite having adequate time and opportunity for sleep. Poor nighttime sleep quality is associated with reduced quality of life and unremitting daytime fatigue. Each of these traits is linked to diminished cancer patient survival [8,9,10]. Surveys of sleep disturbances between different groups of cancer patients report prevalence rates from a low of 24% to a high of 95% [9]. These observations suggest that circadian organization has the potential to tell us a great deal about the overall health of cancer patients [7]
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