Irregular Sleep/Wake Patterns Are Associated With Reduced Quality of Life in Post-treatment Cancer Patients: A Study Across Three Cancer Cohorts

Abstract

Background: Cancer patients often describe poor sleep quality and sleep disruption as contributors to poor quality of life (QoL). In a cross-sectional study of post-treatment breast, endometrial, and melanoma cancer patients, we used actigraphy to quantify sleep regularity using the sleep regularity index (SRI), and examined relationships with reported sleep symptoms and QoL.Methods: Participants were recruited post-primary treatment (35 diagnosed with breast cancer, 24 endometrial cancer, and 29 melanoma) and wore an actigraphy device for up to 2 weeks and SRI was calculated. Self-report questionnaires for cancer-related QoL [European Organization for Research and Treatment of Cancer EORTC (QLQ-C30)] were completed. Data were compared using analysis of variance (ANOVA) or Chi-Square tests. Multivariate linear regression analysis was used to determine independent variable predictors for questionnaire-derived data.Results: Age distribution was similar between cohorts. Endometrial and breast cancer cohorts were predominantly female, as expected, and body mass index (BMI) was higher in the endometrial cancer cohort, followed by breast and melanoma. There were no differences between tumor groups in: total sleep time, sleep onset latency, bedtime, and SRI (breast 80.9 ± 8.0, endometrial 80.3 ± 12.2, and melanoma 81.4 ± 7.0) (all p > 0.05). A higher SRI was associated with both better functional and symptom scores, including increased global QoL, better physical functioning, less sleepiness and fatigue, better sleep quality, and associated with less nausea/vomiting, dyspnea, and diarrhea (all p < 0.05).Conclusion: In cancer patients post-treatment, greater sleep regularity is associated with increased global QoL, as well as better physical functioning and fewer cancer related symptoms. Improving sleep regularity may improve QoL for cancer patients.

Evaluation of Patient-Reported Symptoms and Functioning after Treatment for Endometrial Cancer

“…Good sleep patterns were associated with increased global QOL as well as better physical functioning. Patients with regular sleep patterns also reported less nausea/vomiting, dyspnea, and diarrhea [ 34 ]. Further studies should incorporate sleep regularity as a factor analysis.…”

Cancer sleep symptom‐related phenotypic clustering differs across three cancer specific patient cohorts

“…Each of the above questionnaires has an associated and validated scoring system that is used to quantify an overall outcome based on the individual question responses. The overall questionnaire score data for the patients were not included in the current analysis, although results for some have been reported separately (Madut et al, 2021 ; Trivedi et al, 2021 ). For the purposes of the present study, demographic data and individual question response data were extracted from each completed questionnaire, in addition to systolic and diastolic blood pressure, with the resulting database serving as the data set for cluster analysis.…”

“…Sleep quality and sleepiness are not shown as they were not binary variables the individual question responses. The overall questionnaire scoredata for the patients were not included in the current analysis, although results for some have been reported separately(Madut et al, 2021;Trivedi et al, 2021). For the purposes of the present study, demographic data and individual question response data were extracted from each completed questionnaire, in addition to systolic and diastolic blood pressure, with the resulting database serving as the data set for cluster analysis.To achieve efficient clustering, based on reported symptoms, responses to all individual questions from ISI and FOSQ-10, questions 5-8 (except 5j) of PSQI (see Appendix S1 for questionnaires), questions 1-3 of STOP-BANG, and ESS total scores (0-24) were used to create individual "symptom-variables"; each symptomvariable representing a specific sleep symptom (i.e.…”

Ethnic/racial discrimination and academic grades among adolescents: moderation by sleep regularity

“…Sleep regularity, the consistency with which one keeps a regular sleep onset and offset schedule, is a relatively new indicator of sleep health (Bei et al, 2016; Fischer et al, 2021; Lunsford‐Avery et al, 2018; Phillips et al, 2017). Existing research suggests that irregular sleep patterns are associated with poor health and academic outcomes (Phillips et al, 2017; Trivedi et al, 2021). Early indicators of sleep regularity relied on person‐level estimates of whether an individual typically keeps a regular (or irregular) sleep schedule based on deviations from average sleep onset and offset times.…”

“…Sleep regularity, the consistency with which one keeps a regular sleep onset and offset schedule, is a relatively new indicator of sleep health (Bei et al, 2016;Fischer et al, 2021;Lunsford-Avery et al, 2018;Phillips et al, 2017). Existing research suggests that irregular sleep patterns are associated with poor health and academic outcomes (Phillips et al, 2017;Trivedi et al, 2021) Ethnic/racial discrimination is a normative, adverse experience for ethnic/racial minority adolescents that has been linked to poor sleep and developmental outcomes (Yip, 2015). Moreover, poor sleep has been observed to exacerbate the negative association between discrimination and psychological adjustment and mental health outcomes (El-Sheikh et al, 2021;.…”