Approaches to Measure Sleep–Wake Disturbances in Adolescents With Cancer

Abstract

Sleep-wake disturbances commonly occur in healthy adolescents. While diminished sleep and sleepiness seem normal for healthy adolescents, adolescents with chronic illnesses face additional disruption in the quantity and quality of their sleep as a result of the disease process, ongoing treatment, and associated symptoms. Little is known about how sleep in adolescents is affected by cancer, cancer treatment, and concurrent symptoms or about the consequences of sleep disruption for these patients. Although there is limited evidence to guide sleep measurement in adolescents with cancer, researchers may learn effective strategies from sleep studies completed with adolescents with other conditions. This systematic review examines how researchers have measured sleep using actigraphy, diary, and/or self-report questionnaires in diverse samples of healthy and ill adolescents. Psychometric properties are reported for nine self-report sleep questionnaires that were used in studies with mostly healthy adolescent samples. Nineteen studies provide evidence that actigraphy can be successfully and reliably used as an effective objective method to measure sleep in adolescents, including those with chronic illness. Daily sleep diaries were used less frequently to collect data from adolescents. The suitability of these techniques for the study of cancer-related sleep-wake disturbances in adolescents as well as strategies to enhance the reliability, validity, and feasibility of these measures will be discussed. Future sleep research in adolescents affected by cancer can be strengthened by the consistent use of sleep terminology, measurement of key sleep parameters, and efforts to develop and use psychometrically sound instruments. Oncology clinicians should be ready to add emerging evidence from sleep research to their care of adolescents with cancer.The problems of insufficient sleep and daytime sleepiness are critical problems for American adolescents. These sleep-wake disturbances result as several unique physiological, psychosocial, and behavioral factors converge during this developmental stage. Research has shown that an internal sleep phase delay toward later bedtimes and increased daytime sleepiness are normal changes that occur during adolescence (Millman, 2005). In addition, teenagers get less sleep as they assume greater independence from parents, take on increasing work and academic demands, and participate in social activities with peers. The consequences of insufficient sleep and daytime sleepiness include such significant negative outcomes as increased automobile accidents, increased substance abuse, decreased academic performance, Preliminary work was presented as a poster at the UICC World Cancer Congress in Washington, DC in July 2006.There is no commercial financial support of this work.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo...

Incorporating measures of sleep quality into cancer studies

“…Wrist actigraphy, obtained with the use of miniaturized accelerometers, is a reliable and valid measure of activity-rest in adults [67] and adolescents [68] and has frequently been used to measure sleep of children with cancer and others, despite concerns about sensitivity to wake and measurement of naps [69]. Sleep is estimated from the patterns of activity-rest using commercially available computer algorithms in specialized software.…”

“…Wrist actigraphy has frequently been used to evaluate the sleep and circadian patterning of activity-rest among cancer patients, including adults [59, 71–73], adolescents, [68, 74], children [75], and family caregivers [76]. Given the ability to monitor activity-rest and sleep over many days depending on storage capacity and epoch length, actigraphs are especially useful in monitoring changes over the trajectory of cancer treatment and recovery.…”

“…Examples of reliable and valid sleep questionnaires used in cancer research include the General Sleep Disturbances Questionnaire [32, 79] and the Pittsburgh Sleep Quality Index [79–81], and the insomnia severity index [81]. Additional measures have been reviewed for use in adult, child, adolescent, and caregiver cancer populations [36, 68]. …”

Pain assessment in children with cancer: a systematic review

“…The sleep pattern was assessed through numerical or visual analogue scales or the actigraph. There are no psychometric evidence for the use of numerical or visual analogue scales (Erickson, 2009). These scales assess the duration and quality of sleep and the number of awakenings in a retrospective way (Baggott et al, 2012;Jacob et al, 2007).…”

“…The actigraph is a promising method to assess the sleep pattern in these children by allowing for an objective measurement of the duration and efficiency of sleep and the number of awakenings (Docherty et al, 2006;Gedaly-Duff et al, 2006;Linder & Christian, 2013). Its clinical usefulness is confirmed, and its high cost is the only barrier to its clinical use (Erickson, 2009). The assessment of the physical functioning, in which fatigue was the most commonly assessed symptom, an integrative role in understanding the child's painful experience, thus making it possible for health care professionals to provide a more accurate diagnosis and treatment (Jacob et al, 2007;Jacob et al, 2008).…”