Relationship between subjective and actigraphy-measured sleep in 237 patients with metastatic colorectal cancer

Abstract

Objective Patients with cancers frequently experience sleep and circadian dysfunction. To date, only a few studies have used both a questionnaire and actigraphy for concomitant evaluation of sleep and circadian function in patients with cancer. We sought to evaluate objective sleep and circadian parameters in metastatic colon cancer (MCC) patients and their associations with symptoms and quality of life (QOL). Methods Patients reported subjective sleep problems on the EORTC QLQ-C30. Sleep and circadian parameters were calculated using a wrist-actigraph that patients wore for 72 hours. Results 237 Patients with MCC (age: 60.4 years; range: 20.7–77.6; Male/Female ratio: 1.66) participated in this cross-sectional study. Subjective sleep problems were reported by 63.4% of patients (S+). No differences in any sleep parameters (sleep efficiency, sleep latency, total sleep time, total time in bed, wake after sleep onset, activity bathyphase) were observed between S+ and S- patients. However, S+ patients displayed a significantly worse circadian function than S-patients (96.4% versus 98.1%; p=.005). Presence of poor subjective sleep and objective circadian dysfunction negatively affected symptoms and QOL domains (p=.038). Conclusions Subjective report of sleep problems was not associated with worse objectively-measured sleep parameters in patients with MCC although it was associated with disrupted circadian rest-activity rhythm and poorer QOL. These findings coincide with prior research in cancer patients in that an inconsistent relationship exists between subjective and objective sleep measurements on some sleep domains. This study supports the value of coupled evaluation of self-reported and objective measures of sleep and circadian function in cancer patients.

Does Spinal Cord Stimulation Really Influence Sleep?

“…TST was underestimated with approximately one hour compared to subjective reports . Several other studies have confirmed this systematic underestimation in several chronic pain pathologies . Second, the Bland and Altman plot also revealed that patients who slept for a shorter period, underestimated their TST to a higher degree than patients with a longer TST.…”

Clinical chronobiology: a timely consideration in critical care medicine

“…A more sophisticated approach would require quantitative analysis of rhythms, perhaps via software able to process real-time physiological data, to identify: timing of peaks (or troughs) enabling phase shift determination; amplitude of variation, from peak to trough; and the consistency of the rhythm over days. Techniques to achieve this are commonly used in the experimental setting [ 89 ], but have yet to transfer across to clinical practice. Medical education in the future may need to provide clinicians with the mathematical competence to handle more complex data relating to biological rhythms, or to use algorithms for their interpretation.…”

<p>Sleep, a Governor of Morbidity in PTSD: A Systematic Review of Biological Markers in PTSD-Related Sleep Disturbances</p>

“…Incorporation of such a measurement would allow for greater comparability with previous studies, and may prove more robust than objective actigraphy alone. 17 , 18 , 110 Therefore, this review recommends future research should report raw accelerometer movement data, in actigraphy-based studies, where possible. This should also be accompanied by a validated self-report sleep measure.…”

“…Modern sleep research has capitalized on advancements in wearable technology to provide objective measures of sleep in the free-living environment. [15][16][17][18] Actigraphy is the most common method, and involves participants wearing a personal accelerometer device, normally on the wrist, to record movement during sleep. [19][20][21] This movement data is then translated to provide information about a participants' sleep.…”