Evaluation and Management of Sleep and Circadian Rhythm Disturbance in Cancer

Abstract

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A multidisciplinary perspective on the complex interactions between sleep, circadian, and metabolic disruption in cancer patients

“…Sleep disorders include a broad range of sleep-related phenotypes commonly found in cancer patients and which can be associated to the disease and/or treatment. These include restless legs syndrome and other sleep movement disorders, hypersomnolence (i.e., sleepiness during the day even after a full night’s sleep), sleeping-disordered breathing, including sleep apnea, and insomnia [ 2 ]. While each of these conditions has specific criteria that can be employed for accurate diagnosis (reviewed by Belachandran et al [ 2 ]), they are commonly grouped under the umbrella “sleep disruption.” These conditions should, however, not be mistaken for other closely related quality of life indicators such as cancer-related fatigue, which is a different but often comorbid condition, that has a distinct etiology and mechanism, as recently reviewed by Saligan et al [ 35 ].…”

“…Insufficient sleep quality and/or duration has become one of the most prevalent, elective risk factors for cancer as well as treatment failure and poor quality of life in cancer patients[ 1 ]. While the reasons for these effects of poor or little sleep are poorly understood, it is established that insufficient sleep and/or irregular sleep patterns such as seen in people frequently working shifts affect cancer initiation, progression, and treatment [ 2 ]. This occurs mainly through disrupting physiological circadian rhythms, biological processes that are normally engaged in a rhythmic manner, and with a frequency of approximately 24 h. Sleep disruption affects circadian function at all biological scales including interfering with distinct molecular interactions inside the cell, which affects cellular physiology, tissue homeostasis, and the physiology of the whole organism [ 1 ].…”

“…Circadian dysfunction due to sleep disruption can commonly be classified by five main criteria (Fig. 1 ): (1) behavioral sleep disruption also known as social jet lag, occurring due to social or occupational shifts in the active period from the day to the night or vice versa, or poor night-time sleep quality due to for example alcohol or substance (ab)use [ 3 ]; (2) frequent jet lag which arise from traveling across multiple time zones [ 4 ]; (3) anxiety, noise or light pollution, or insomnia due to other reasons related to restlessness of the body or mind [ 2 ]; (4) pain, nausea, or other types of non-psychological discomfort [ 2 ]; and (5) genetic disruption of genes involved in circadian rhythmicity or sleep [ 5 ]. In all these cases, sleep disruption, through dysregulation of the circadian clock, leads to an inability of the organism to maintain the circadian rhythm of key biological functions including metabolism, angiogenesis, immunity, DNA repair, and cell cycle regulation, all being hallmarks of cancer [ 1 , 2 , 6 ].…”

“…1 ): (1) behavioral sleep disruption also known as social jet lag, occurring due to social or occupational shifts in the active period from the day to the night or vice versa, or poor night-time sleep quality due to for example alcohol or substance (ab)use [ 3 ]; (2) frequent jet lag which arise from traveling across multiple time zones [ 4 ]; (3) anxiety, noise or light pollution, or insomnia due to other reasons related to restlessness of the body or mind [ 2 ]; (4) pain, nausea, or other types of non-psychological discomfort [ 2 ]; and (5) genetic disruption of genes involved in circadian rhythmicity or sleep [ 5 ]. In all these cases, sleep disruption, through dysregulation of the circadian clock, leads to an inability of the organism to maintain the circadian rhythm of key biological functions including metabolism, angiogenesis, immunity, DNA repair, and cell cycle regulation, all being hallmarks of cancer [ 1 , 2 , 6 ]. Indeed, shift work was in the Nurse’s Health Study, a large epidemiological study including almost 200 000 individuals and 24 years of follow-up, found to increase the risk of breast cancer by 2.2 fold, particularly when shift work started as a young adult [ 7 ], and was in 2019 recognized by the International Agency for Research on Cancer as probably carcinogenic to humans (Class 2A) [ 8 ].…”

Early-Onset Cancers in Adults: A Review of Epidemiology, Supportive Care Needs and Future Research Priorities

“…Given the potential decades of life left for these young patients, developing measures to improve their quality of life, such as physical activity interventions [ 54 , 55 ], management of sleep disorders [ 56 ], holistic needs assessment [ 57 ] and psychosocial care [ 58 ] would enable individual needs to be addressed and allow patients to access relevant support services. This in turn, could lead to an improvement of quality of life.…”