Prevalence of Insomnia in an Oncology Patient Population: An Irish Tertiary Referral Center Experience

Abstract

Background: The NCCN Guidelines for Survivorship recommend dedicated sleep assessment. Reported insomnia prevalence in the general Irish population is 6% to 15%. Reported insomnia prevalence internationally among new/recently diagnosed patients with cancer varies from 30.9% to 54.3%. Insomnia prevalence has not been previously quantified in an Irish oncology cohort. Methods: A 40-item questionnaire was prospectively administered to ambulatory patients with cancer aged ≥18 years. Prespecified criteria to define insomnia syndrome combined those of the International Classification of Sleep Disorders, version 1, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The Hospital Anxiety and Depression Scale-Depression/Anxiety (HADS-D/A) was used to screen for potential confounding variables. Results: The response rate to the questionnaire was 87% (294/337). The predominant respondent age group was 55 to 64 years (26%; 77/294), 70.7% were female (208/294), and the most common cancer subtypes were breast (37.4%), colorectal (12.9%), and lung (12.2%). A total of 62% (183/294) of patients reported sleep disturbance after diagnosis, 63% (115/183) reported moderate/severe distress related to this disturbance, and 37% (61/183) reported a significant impact on physical function. Although 33% (98/294) met insomnia syndrome criteria, only 34% (33/98) of these patients had a preexisting history of sleep disturbance. Female sex, age <65 years, cancer subtype, alcohol consumption, and HADS-D/A ≥11 were associated with statistically significant higher odds ratios (OR) of insomnia syndrome. Multivariate analysis identified breast cancer (OR, 3.17; P=.01), age <65 years (OR, 1.8; P=.03), and alcohol consumption (OR, 2.3; P=.005) as independent predictors of insomnia syndrome. Conclusions: Insomnia syndrome prevalence in this cohort is comparable to that reported previously and supports dedicated sleep assessment. This study identifies potentially modifiable risk factors for insomnia and demonstrates additional utility of the HADS score in identifying patients at risk.

Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer

“…In a survey of 125 patients with breast cancer of any stage from the Memorial Sloan Kettering Cancer Center, patients reporting sleep problems had a median age of 51.3 years compared to 56.6 years in patients without sleep problems (p<0.10) (24). More recently, in a study from Ireland including 294 patients with different cancer types (37% patients with breast cancer), age <65 years was an independent predictor of insomnia (odds ratio=1.8, 95% confidence interval=1.1-3.4; p=0.03) (25). (7) Associations between chemotherapy and sleep disorders were also previously described.…”

Sleep disturbance in primary brain tumor: prevalence, risk factors, and patient preferences

“…As many as 60% of cancer patients report symptoms of sleep disturbance, a rate 2–3 times higher than that of the general population [ 2 , 3 ]. More recent studies suggest that nearly a third of cancer patients endorse severe insomnia with nearly two-thirds advocating for more consistent assessment of their sleep as part of their cancer care [ 4 , 5 ]. Among individuals with cancer, sub-optimal sleep is associated with a range of adverse physical, psychological, and functional consequences including increased pain, fatigue, and depression [ 6 , 7 ].…”

Prospective Rates, Longitudinal Associations, and Factors Associated With Comorbid Insomnia Symptoms and Perceived Cognitive Impairment

“…When symptoms occur at least 3 times per week and have been present for at least 3 months, the diagnostic criteria for insomnia disorder are met. Estimates suggest that roughly 40–60% of patients will present with insomnia symptoms and that around 20% will meet the criteria for a disorder at the time of diagnosis ( Savard et al, 2011 ; Fleming et al, 2018 ; Harrold et al, 2020 ). Even after treatment completion, the prevalence of insomnia symptoms or disorder remains up to three times greater than in the general population, with a prevalence of insomnia symptoms of 47% at 12 months ( Fleming et al, 2018 ) and 36% at 18 months ( Savard et al, 2011 ) compared to roughly 6–10% ( Ohayon, 2002 ; Buysse, 2013 ).…”

“…Patients who experience insomnia at the time of their cancer diagnosis are significantly more likely to report persistent insomnia, compared to those who identify as good sleepers ( Savard et al, 2011 ), which emphasizes the importance of early identification and intervention. Factors associated with cancer-related insomnia include younger age ( Harrold et al, 2020 ), having a diagnosis of a breast or gynecological cancer ( Savard et al, 2011 ; Harrold et al, 2020 ), receiving chemotherapy ( Fleming et al, 2018 ), and experiencing comorbid anxiety or depression ( Hoang et al, 2019 ; Maguire et al, 2019 ). Insomnia in cancer survivors has been associated with greater overall symptoms burden including higher levels of pain, fatigue, anxiety, and depression ( Nishiura et al, 2015 ).…”