Actigraphy and Sleep Diary Measurements in Breast Cancer Survivors: Discrepancy in Selected Sleep Parameters

Moore, Camille M.; Schmiege, Sarah J.; Matthews, Ellyn E.

doi:10.1080/15402002.2014.940108

Cited by 44 publications

(42 citation statements)

References 48 publications

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“…This observation, particularly when taking into account the time difference between the two data group collection, as well as complementary subgroup and intrasubject dynamic analyses, further supported the reliability of the findings. However, circadian rhythm alterations were only weakly associated with subjective sleep complaints, in line with prior reports . This underscores the importance of obtaining objective as well as subjective reports of sleep quality and quantity …”

Section: Discussionsupporting

confidence: 89%

“…However, circadian rhythm alterations were only weakly associated with subjective sleep complaints, in line with prior reports. 43,44 This underscores the importance of obtaining objective as well as subjective reports of sleep quality and quantity. 45,46 One of our study's limitations is that it does not provide definitive evidence as to whether circadian rhythm disruption is a cause, a consequence, or a correlate of fatigue and anorexia.…”

Section: Discussionmentioning

confidence: 99%

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Circadian rest‐activity rhythm as an objective biomarker of patient‐reported outcomes in patients with advanced cancer

et al. 2018

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BackgroundPsychosocial symptoms often cluster together, are refractory to treatment, and impair health‐related quality of life (HR‐QoL) in cancer patients. The contribution of circadian rhythm alterations to systemic symptoms has been overlooked in cancer, despite a causal link shown under jet lag and shift work conditions. We investigated whether the circadian rest‐activity rhythm provides a reliable and objective estimate of the most frequent patient‐reported outcome measures (PROMs).MethodsTwo datasets were used, each involving concomitant 3‐day time series of wrist actigraphy and HR‐QoL questionnaires: EORTC QLQ‐C30 was completed once by 237 patients with metastatic colorectal cancer; MD Anderson Symptom Inventory (MDASI) was completed daily by 31 patients with advanced cancer on continuous actigraphy monitoring, providing 1015 paired data points. Circadian function was assessed using the clinically validated dichotomy index I < O. Nonparametric tests compared PROMs and I < O. Effect sizes were computed. Sensitivity subgroup and temporal dynamics analyses were also performed.Results I < O values were significantly lower with increasing symptom severity and worsening HR‐QoL domains. Fatigue and anorexia were worse in patients with circadian disruption. The differences were both statistically and clinically significant (P < 0.001; d ≥ 0.33). Physical and social functioning, and global quality/enjoyment of life were significantly better in patients with robust circadian rhythm (P < 0.001; d ≥ 0.26). Sensitivity analyses validated these findings.ConclusionObjectively determined circadian disruption was consistently and robustly associated with clinically meaningfully severe fatigue, anorexia, and interference with physical and social functioning. This supports an important role of the circadian system in the determination of cancer patients’ HR‐QoL and symptoms that deserves therapeutic exploitation.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Circadian rest‐activity rhythm as an objective biomarker of patient‐reported outcomes in patients with advanced cancer

et al. 2018

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Section: Discussionsupporting

confidence: 88%

“…[15; 35] While our findings are in line with prior research in cancer patients, Moore and colleagues (2015) propose that the discrepancy can be potentially explained by the “importance of sleep perception” in medically ill populations with comorbid sleep disturbance. Patients might overestimate or underestimate their sleep problems,[35] creating lack of agreement between self-reported sleep and actigraphy-measured sleep. Additionally, while actigraphy is accurate in measuring sleep in healthy populations, de Souza and colleagues found that, even in healthy participants, actigraphy overestimates sleep latency (SL), total sleep time (TST), and sleep efficiency (SE), while it underestimates awakenings compared to the gold standard of polysomnography measurement.…”

Section: Discussionsupporting

confidence: 88%

Relationship between subjective and actigraphy-measured sleep in 237 patients with metastatic colorectal cancer

et al. 2017

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Objective Patients with cancers frequently experience sleep and circadian dysfunction. To date, only a few studies have used both a questionnaire and actigraphy for concomitant evaluation of sleep and circadian function in patients with cancer. We sought to evaluate objective sleep and circadian parameters in metastatic colon cancer (MCC) patients and their associations with symptoms and quality of life (QOL). Methods Patients reported subjective sleep problems on the EORTC QLQ-C30. Sleep and circadian parameters were calculated using a wrist-actigraph that patients wore for 72 hours. Results 237 Patients with MCC (age: 60.4 years; range: 20.7–77.6; Male/Female ratio: 1.66) participated in this cross-sectional study. Subjective sleep problems were reported by 63.4% of patients (S+). No differences in any sleep parameters (sleep efficiency, sleep latency, total sleep time, total time in bed, wake after sleep onset, activity bathyphase) were observed between S+ and S- patients. However, S+ patients displayed a significantly worse circadian function than S-patients (96.4% versus 98.1%; p=.005). Presence of poor subjective sleep and objective circadian dysfunction negatively affected symptoms and QOL domains (p=.038). Conclusions Subjective report of sleep problems was not associated with worse objectively-measured sleep parameters in patients with MCC although it was associated with disrupted circadian rest-activity rhythm and poorer QOL. These findings coincide with prior research in cancer patients in that an inconsistent relationship exists between subjective and objective sleep measurements on some sleep domains. This study supports the value of coupled evaluation of self-reported and objective measures of sleep and circadian function in cancer patients.

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“…Equally constructive would be a head-to-head comparison of the app and subjective measures such as sleep diaries and questionnaires. Such instruments, while widely used in clinical practice despite conflicting reports of their reliability, [17][18][19][20] require active patient involvement and motivation, and are often abandoned as being burdensome and inconvenient. Sleep apps such as this one that passively collect comparable data may represent a potential substitute for sleep diaries, especially in patients with poor motivation to maintain useful logs of their sleep.…”

Section: (20%)mentioning

confidence: 99%

Is There a Clinical Role For Smartphone Sleep Apps? Comparison of Sleep Cycle Detection by a Smartphone Application to Polysomnography

Bhat

Ferraris

Gupta

et al. 2015

Journal of Clinical Sleep Medicine

113

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Study Objectives: Several inexpensive, readily available smartphone apps that claim to monitor sleep are popular among patients. However, their accuracy is unknown, which limits their widespread clinical use. We therefore conducted this study to evaluate the validity of parameters reported by one such app, the Sleep Time app (Azumio, Inc., Palo Alto, CA, USA) for iPhones. Methods: Twenty volunteers with no previously diagnosed sleep disorders underwent in-laboratory polysomnography (PSG) while simultaneously using the app. Parameters reported by the app were then compared to those obtained by PSG. In addition, an epoch-by-epoch analysis was performed by dividing the PSG and app graph into 15-min epochs. S martphones are now ubiquitous. As their technological capabilities continue to improve, both consumers and healthcare personnel are constantly fi nding new and innovative uses for smartphone apps in the fi eld of health and medicine.1 Apps have been incorporated into the practice of medical specialties as diverse as diabetology and neurosurgery, and have found a role in activities ranging from interpretation of radiology imaging to smoking cessation counseling. Sleep related concerns are commonplace as well, and given the burgeoning popularity and easy availability of inexpensive apps that purport to monitor multiple physiological parameters, it is not surprising that several apps have been designed to evaluate sleep quality.2 The inexorable permeation of smartphones into the fi eld of sleep medicine has resulted in the development of promising apps that screen for obstructive sleep apnea (OSA) 3,4 and periodic limb movements in sleep (PLMS). S C I E N T I F I C I N V E S T I G AT I O N Sinsomnia, circadian rhythm disorders, and hypersomnolence to have objective data about sleep patterns in order to make diagnoses and treatment recommendations. There are several apps that allow users to report and analyze their sleep quality and duration, 6 but such data are often intrinsically subjective. In-laboratory polysomnography (PSG) is the gold standard for BRIEF SUMMARY Current Knowledge/Study Rationale: There are several preexisting, widely available, inexpensive smartphone apps designed to monitor sleep, but it is unclear whether they have clinical utility. Our goal was to systematically compare the results obtained by using one such app, the Sleep Time app (Azumio, Inc.) to the gold standard, polysomnography (PSG). Study Impact: Our study shows that the absolute parameters and sleep staging reported by the Sleep Time app (Azumio, Inc.) for iPhones correlate poorly with PSG. Further studies comparing app sleep-wake detection to actigraphy may help elucidate its potential clinical utility.

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Actigraphy and Sleep Diary Measurements in Breast Cancer Survivors: Discrepancy in Selected Sleep Parameters

Cited by 44 publications

References 48 publications

Circadian rest‐activity rhythm as an objective biomarker of patient‐reported outcomes in patients with advanced cancer

Circadian rest‐activity rhythm as an objective biomarker of patient‐reported outcomes in patients with advanced cancer

Relationship between subjective and actigraphy-measured sleep in 237 patients with metastatic colorectal cancer

Is There a Clinical Role For Smartphone Sleep Apps? Comparison of Sleep Cycle Detection by a Smartphone Application to Polysomnography

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