Alterations of the Characteristics of the Circadian Rest‐Activity Rhythm of Cancer In‐Patients

Abstract

The aim of the present study was to evaluate the characteristics of the circadian rest-activity rhythm of cancer patients. Thirty-one in-patients, consisting of 19 males and 12 females, were randomly selected from the Regional Cancer Center, Pandit Jawaharlal Nehru Medical College, Raipur, India. The rest-activity rhythm was studied non-invasively by wrist actigraphy, and compared with 35 age-matched apparently healthy subjects (22 males and 13 females). All subjects wore an Actiwatch (AW64, Mini Mitter Co. Inc., USA) for at least 4-7 consecutive days. Fifteen-second epoch length was selected for gathering actigraphy data. In addition, several sleep parameters, such as time in bed, assumed sleep, actual sleep time, actual wake time, sleep efficiency, sleep latency, sleep bouts, wake bouts, and fragmentation index, were also recorded. Data were analyzed using several statistical techniques, such as cosinor rhythmometry, spectral analysis, ANOVA, Duncan's multiple-range test, and t-test. Dichotomy index (I<O) and autocorrelation coefficient (r24) were also computed. The results validated a statistically significant circadian rhythm in rest-activity with a prominent period of 24 h for most cancer patients and control subjects. Results of this study further revealed that cancer patients do experience a drastic alteration in the circadian rest-activity rhythm parameters. Both the dichotomy index and r24 declined in the group of cancer patients. The occurrence of the peak (acrophase, Ø) of the rest-activity rhythm was earlier (p<0.001) in cancer patients than age- and gender-matched control subjects. Results of sleep parameters revealed that cancer patients spent longer time in bed, had longer assumed and actual sleep durations, and a greater number of sleep and wake bouts compared to control subjects. Further, nap frequency, total nap duration, average nap, and total nap duration per 1 h awake span were statistically significantly higher in cancer patients than control subjects. In conclusion, the results of the present study document the disruption of the circadian rhythm in rest-activity of cancer in-patients, with a dampening of amplitude, lowering of mean level of activity, and phase advancement. These alterations of the circadian rhythm characteristics could be attributed to disease, irrespective of variability due to gender, sites of cancer, and timings of therapies. These results might help in designing patient-specific chronotherapeutic protocols.

The effect of melatonin on sleep and quality of life in patients with advanced breast cancer

“…1a and 2d-f respectively) [31]. This is consistent with the lack of any significant impact on the diurnal pattern of cortisol (Fig.…”

“…Nine other parameters were calculated: three estimating the circadian rest-activity pattern (dichotomy index, I<O [29]; intraday variability, IV; and interday stability, IS [30]), one estimating sleep (sleep fragmentation index, SFI [31]), and five related to physical activity (average activity counts; average duration of rest; a probabilistic metric of activity fragmentation, pAR that is analogous to pRA [27]; average activity during 6 most active hours, M6; and during 6 least active hours, L6). Finally, the actigraph provided two estimates of the phase of the activity pattern using a cosine regression (acrophase) or a non-parametric analysis of the average clock time of the midpoint of the eight most active hours of each day (M8) [32].…”

Amplitude of the rest&ndash;activity cycle in chronic obstructive pulmonary disease: an exploratory study

“…Increased comorbidity in our low-RA group is consistent with reduced amplitude of the circadian rest-activity cycle reported in other disease conditions, such as hypertension, 4 cancer, 1 and mood disorders, 46 all conditions taken into account by the COTE index. In their study of schizophrenia patients, Bromundt et al 19 found that low amplitude could be associated with disturbances of circadian rhythms, as shown by a delayed onset of melatonin secretion in relation to sleep time, and they proposed that circadian asynchrony may explain the strong association they found between low amplitude and low scores on many tests of cognitive functions.…”

“…Studies on a variety of medical disorders, including cancer, 1 Alzheimer's disease, 2,3 and hypertension, 4 have found that larger amplitude in rest-activity rhythms is associated with lower disease severity and better prognosis. Rest-activity rhythms are usually measured with continuous actigraphic recordings, a technique that has the advantage of being noninvasive and providing results that are representative of patients' usual behavior.…”

Association between PER3 length polymorphism and onco-hematological diseases and its influences on fatigue on awakening in patients

“…Cancer patients take longer time to fall asleep, wake up more often, spend more time in bed and nap more frequently than healthy individuals [32,33] . On the other hand, genetic, environmental or behavioral factors may favor circadian disruption, predisposing patients to tumor development [34] .…”