Validation of actigraphy to assess circadian organization and sleep quality in patients with advanced lung cancer

Abstract

BackgroundMany cancer patients report poor sleep quality, despite having adequate time and opportunity for sleep. Satisfying sleep is dependent on a healthy circadian time structure and the circadian patterns among cancer patients are quite abnormal. Wrist actigraphy has been validated with concurrent polysomnography as a reliable tool to objectively measure many standard sleep parameters, as well as daily activity. Actigraphic and subjective sleep data are in agreement when determining activity-sleep patterns and sleep quality/quantity, each of which are severely affected in cancer patients. We investigated the relationship between actigraphic measurement of circadian organization and self-reported subjective sleep quality among patients with advanced lung cancer.MethodsThis cross-sectional and case control study was conducted in 84 patients with advanced non-small cell lung cancer in a hospital setting for the patients at Midwestern Regional Medical Center (MRMC), Zion, IL, USA and home setting for the patients at WJB Dorn Veterans Affairs Medical Center (VAMC), Columbia, SC, USA. Prior to chemotherapy treatment, each patient's sleep-activity cycle was measured by actigraphy over a 4-7 day period and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire.ResultsThe mean age of our patients was 62 years. 65 patients were males while 19 were females. 31 patients had failed prior treatment while 52 were newly diagnosed. Actigraphy and PSQI scores showed significantly disturbed daily sleep-activity cycles and poorer sleep quality in lung cancer patients compared to healthy controls. Nearly all actigraphic parameters strongly correlated with PSQI self-reported sleep quality of inpatients and outpatients.ConclusionsThe correlation of daily activity/sleep time with PSQI-documented sleep indicates that actigraphy can be used as an objective tool and/or to complement subjective assessments of sleep quality in patients with advanced lung cancer. These results suggest that improvements to circadian function may also improve sleep quality.

Correlation between rest-activity rhythm and survival in cancer patients experiencing pain

“…This study used an actigraph device (Ambulatory Monitoring Inc., New York, NY) attached to the patients' wrists for the collection of sleep-related data, which was then analyzed using Action4 software, after being downloaded in zero crossing mode. This device is an effective tool for the collection of data related to the rest-activity rhythm of cancer patients (Grutsch et al, 2011).…”

“…Actigraphy employs a medical instrument to detect and record changes in activity and muscle tone (Grutsch et al, 2011). This study used an actigraph device (Ambulatory Monitoring Inc., New York, NY) attached to the patients' wrists for the collection of sleep-related data, which was then analyzed using Action4 software, after being downloaded in zero crossing mode.…”

Circadian actigraphic rest–activity rhythms following surgery for endometrial cancer: A prospective, longitudinal study

“…Cross-sectional actigraphic studies in breast, metastatic colorectal, and non-small cell lung cancer populations have demonstrated associations between indices indicating greater dysregulation of circadian rest-activity rhythms (including lower mean activity level, less differentiated highest and lowest activity values, and delayed timing of peak activity) and greater sleep disturbance, fatigue, depressive symptoms, anxiety symptoms, and body mass index (BMI) [4-8]. Less rest-activity consistency has also been associated with flattened cortisol rhythms in breast and metastatic colorectal patients and increased inflammation and tumor-related symptoms in metastatic colorectal patients [9, 10].…”

Relationships of Circadian Rhythms and Physical Activity With Objective Sleep Parameters in Lung Cancer Patients

“…18,46,47 It was suggested that treatments designed to improve circadian rhythms may also improve the sleep quality and QOL of cancer patients. 48 The American College of Sport Medicine 29 suggests that patients engage in moderate-intensity physical activity for 30 minutes each time, 5 times per week. We found that only 15.9% of patients achieved 150 min/wk of moderate-intensity physical activity as recommended by the public-health physical activity guidelines, 29 which is similar to Lin and colleagues' 28 report that 17% of Taiwanese lung cancer patients achieved the same suggested guidelines during active treatment.…”