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Sleep disturbance in adults with untreated primary brain tumors: prevalence and impact on quality of life

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Abstract

Purpose

To investigate the frequency of sleep disturbance and its effects on quality of life in adults with untreated primary brain tumors.

Methods

This cross-sectional study recruited 68 and 35 patients with newly diagnosed benign and malignant brain tumors, respectively. All participants completed the Chinese versions of the Athens Insomnia Scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, and EORTC-QLQ-BN20 for quality-of-life assessment. An actigraph was used to measure sleep parameters [e.g., dichotomy index (I < O)], for at least 3 consecutive days in untreated status.

Results

The majority of the patients with benign and malignant tumors had meningioma (57.4%) and glioblastoma (40%), respectively. The prevalence of insomnia, poor sleep quality, and excessive daytime sleepiness was 59.2%, 77.7%, and 4.9%, respectively. The prevalence rates of sleep disturbances were not affected by tumor locations (suprasellar vs. non-suprasellar tumors) and tumor types (benign vs. malignant tumors). Only 36 participants completed actigraphy assessments (I < O = 95.4) due to having a tight schedule, actigraph malfunction, or not having the habit of wearing a wristwatch; 61% of them experienced circadian rhythm disruption (I < O ≤ 97.5). Insomnia was the only sleep parameter that significantly affected quality of life after controlling for potential confounders (B = 0.54, p = 0.03, adjusted R2 = 0.60).

Conclusion

More than 60% of the patients with primary malignant and benign brain tumors experienced insomnia, poor sleep quality, and circadian rhythm disruption. Insomnia was independently correlated with quality of life in untreated status. Health-care providers can apply these findings to design effective interventions targeting sleep disturbance to improve quality of life in this population.

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Data availability

Data supporting the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Armstrong TS, Shade MY, Breton G, Gilbert MR, Mahajan A, Scheurer ME, et al. Sleep-wake disturbance in patients with brain tumors. Neuro Oncol. 2016;19(3):323–35.

    PubMed Central  Google Scholar 

  2. Armstrong TS, Vera-Bolanos E, Acquaye AA, Gilbert MR, Ladha H, Mendoza T. The symptom burden of primary brain tumors: evidence for a core set of tumor- and treatment-related symptoms. Neuro Oncol. 2016;18(2):252–60.

    Article  PubMed  Google Scholar 

  3. Brown PD, Ballman KV, Rummans TA, Maurer MJ, Sloan JA, Boeve BF, et al. Prospective study of quality of life in adults with newly diagnosed high-grade gliomas. J Neurooncol. 2006;76(3):283–91.

    Article  PubMed  Google Scholar 

  4. Powell C, Guerrero D, Sardell S, Cumins S, Wharram B, Traish D, et al. Somnolence syndrome in patients receiving radical radiotherapy for primary brain tumours: a prospective study. Radiother Oncol. 2011;100(1):131–6.

    Article  PubMed  Google Scholar 

  5. Yavas C, Zorlu F, Ozyigit G, Gurkaynak M, Yavas G, Yuce D, et al. Health-related quality of life in high-grade glioma patients: a prospective single-center study. Support Care Cancer. 2012;20(10):2315–25.

    Article  PubMed  Google Scholar 

  6. Armstrong TS, Shade MY, Breton G, Gilbert MR, Mahajan A, Scheurer ME, et al. Sleep-wake disturbance in patients with brain tumors. Neuro Oncol. 2017;19(3):323–35.

    PubMed  Google Scholar 

  7. Huang J, Zeng C, Xiao J, Zhao D, Tang H, Wu H, et al. Association between depression and brain tumor: a systematic review and meta-analysis. Oncotarget. 2017;8(55):94932–43.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fang H, Tu S, Sheng J, Shao A. Depression in sleep disturbance: a review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med. 2019;23(4):2324–32.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ancoli-Israel S, Liu L, Rissling M, Natarajan L, Neikrug AB, Palmer BW, et al. Sleep, fatigue, depression, and circadian activity rhythms in women with breast cancer before and after treatment: a 1-year longitudinal study. Support Care Cancer. 2014;22(9):2535–45.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chang W-P, Lin C-C. Changes in the sleep-wake rhythm, sleep quality, mood, and quality of life of patients receiving treatment for lung cancer: a longitudinal study. Chronobiol Int. 2017;34(4):451–61.

    Article  PubMed  Google Scholar 

  11. Palesh O, Haitz K, Lévi F, Bjarnason GA, Deguzman C, Alizeh I, et al. Relationship between subjective and actigraphy-measured sleep in 237 patients with metastatic colorectal cancer. Qual Life Res. 2017;26(10):2783–91.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Milanti A, Chan DNS, Li C, So WKW. Actigraphy-measured rest-activity circadian rhythm disruption in patients with advanced cancer: a scoping review. Support Care Cancer. 2021;29(12):7145–69.

    Article  PubMed  Google Scholar 

  13. Chang W-P, Smith R, Lin C-C. Age and rest-activity rhythm as predictors of survival in patients with newly diagnosed lung cancer. Chronobiol Int. 2018;35(2):188–97.

    Article  PubMed  Google Scholar 

  14. Mormont MC, Waterhouse J. Contribution of the rest-activity circadian rhythm to quality of life in cancer patients. Chronobiol Int. 2002;19(1):313–23.

    Article  PubMed  Google Scholar 

  15. Trudel-Fitzgerald C, Zhou ES, Poole EM, Zhang X, Michels KB, Eliassen AH, et al. Sleep and survival among women with breast cancer: 30 years of follow-up within the Nurses’ Health Study. Br J Cancer. 2017;116(9):1239–46.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lin M-R, Chen P-Y, Wang H-C, Lin P-C, Lee H-C, Chiu H-Y. Prevalence of sleep disturbances and their effects on quality of life in adults with untreated pituitary tumor and meningioma. J Neurooncol. 2021;154(2):179–86.

    Article  PubMed  Google Scholar 

  17. Jalali R, Dutta D. Factors influencing quality of life in adult patients with primary brain tumors. Neuro Oncol. 2012;14(4):iv8–iv16.

  18. Okita Y, Narita Y, Miyahara R, Miyakita Y, Ohno M, Shibui S. Health-related quality of life in long-term survivors with Grade II gliomas: the contribution of disease recurrence and Karnofsky Performance Status. Jpn J Clin Oncol. 2015;45(10):906–13.

    Article  PubMed  Google Scholar 

  19. Chiang H-L, Chen H-C, Bai C-H, Che H-H, Lee M-B, Lai S-H, et al. A validation study of the Chinese version of the Athens Insomnia Scale. Taiwan J Psychiatry. 2009;23(1):43–52.

    Google Scholar 

  20. Chen N-H, Johns M-W, Li H-Y, Chu C-C, Liang S-C, Shu Y-H, et al. Validation of a Chinese version of the Epworth sleepiness scale. Qual Life Res. 2002;11(8):817–21.

    Article  PubMed  Google Scholar 

  21. Tsai P-S, Wang S-Y, Wang M-Y, Su C-T, Yang T-T, Huang C-J, et al. Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res. 2005;14(8):1943–52.

    Article  CAS  PubMed  Google Scholar 

  22. Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004;27(7):1255–73.

    Article  PubMed  Google Scholar 

  23. Minors D, Akerstedt T, Atkinson G, Dahlitz M, Folkard S, Levi F, et al. The difference between activity when in bed and out of bed. I. Healthy subjects and selected patients. Chronobiol Int. 1996;13(1):27–34.

  24. Innominato PF, Giacchetti S, Bjarnason GA, Focan C, Garufi C, Coudert B, et al. Prediction of overall survival through circadian rest-activity monitoring during chemotherapy for metastatic colorectal cancer. Int J Cancer. 2012;131(11):2684–92.

    Article  CAS  PubMed  Google Scholar 

  25. Levi F, Dugue PA, Innominato P, Karaboue A, Dispersyn G, Parganiha A, et al. Wrist actimetry circadian rhythm as a robust predictor of colorectal cancer patients survival. Chronobiol Int. 2014;31(8):891–900.

    Article  PubMed  Google Scholar 

  26. Zhang K, Tian J, He Z, Sun W, Pekbay B, Lin Y, et al. Validation of the Chinese version of EORTC QLQ-BN20 for patients with brain cancer. Eur J Oncol Nurs. 2018;27(2): e12832.

    CAS  Google Scholar 

  27. Lin C-C, Chang A-P, Chen M-L, Cleeland C-S, Mendoza T-R, Wang X-S. Validation of the Taiwanese version of the Brief Fatigue Inventory. J Pain Symptom Manag. 2006;32(1):52–9.

    Article  Google Scholar 

  28. Li Q, Lin Y, Hu C, Xu Y, Zhou H, Yang L, et al. The Chinese version of hospital anxiety and depression scale: psychometric properties in Chinese cancer patients and their family caregivers. Eur J Oncol Nurs. 2016;25:16–23.

    Article  PubMed  Google Scholar 

  29. Akinwande MO, Dikko HG, Samson A. Variance inflation factor: as a condition for the inclusion of suppressor variable(s) in regression analysis. Open J Stat. 2015;5(07):754.

    Article  Google Scholar 

  30. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91.

    Article  PubMed  Google Scholar 

  31. Mainio A, Hakko H, Niemela A, Koivukangas J, Rasanen P. Insomnia among brain tumor patients: a population-based prospective study of tumor patients in northern Finland. J Psychosoc Oncol. 2013;31(5):507–16.

    Article  PubMed  Google Scholar 

  32. Nicolaides NC, Vgontzas AN, Kritikou I, Chrousos G. HPA axis and sleep. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, et al., editors. Endotext. South Dartmouth: MDText.com, Inc. 2020

  33. Zoli M, Sambati L, Milanese L, Foschi M, Faustini-Fustini M, Marucci G, et al. Postoperative outcome of body core temperature rhythm and sleep-wake cycle in third ventricle craniopharyngiomas. Neurosurg Focus. 2016;41(6):E12.

    Article  PubMed  Google Scholar 

  34. Foschi M, Sambati L, Zoli M, Pierangeli G, Cecere A, Mignani F, et al. Site and type of craniopharyngiomas impact differently on 24-hour circadian rhythms and surgical outcome. A neurophysiological evaluation. Auton Neurosci. 2017;208:126–30.

    Article  CAS  PubMed  Google Scholar 

  35. Gapstur R, Gross CR, Ness K. Factors associated with sleep-wake disturbances in child and adult survivors of pediatric brain tumors: a review. Oncol Nurs Forum. 2009;36(6):723–31.

    Article  PubMed  Google Scholar 

  36. Redeker NS, Lev EL, Ruggiero J. Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Sch Inq Nurs Pract. 2000;14(4):275–90 (discussion 91–8).

  37. Lis CG, Gupta D, Grutsch JF. The relationship between insomnia and patient satisfaction with quality of life in cancer. Support Care Cancer. 2008;16(3):261–6.

    Article  PubMed  Google Scholar 

  38. Choi H-R, Song I, Park HY, Oh TK. Association between insomnia disorder and mortality among patients who underwent craniotomy for brain tumor resection: a South Korean nationwide cohort study. Sleep Breath. 2022:1–8.

  39. Silvaggi F, Leonardi M, Raggi A, Eigenmann M, Mariniello A, Silvani A, et al. Employment and work ability of persons with brain tumors: a systematic review. Front Hum Neurosci. 2020;14: 571191.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was supported by grants from Chang Gung Memorial Hospital (CMRPG2K0251 and CLRPG2L0051) and the Ministry of Science and Technology, Taiwan (MOST 111-2628-B-038-008 and 111-2314-B-038-033-MY3).

Author information

Author notes

  1. Pei-Ching Lin and Pin-Yuan Chen contributed equally to the work.

Authors and Affiliations

  1. School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan

    Pei-Ching Lin, Mei-Ru Lin & Hsiao-Yean Chiu

  2. Department of Neurosurgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan

    Pei-Ching Lin

  3. Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan

    Pin-Yuan Chen

  4. School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Pin-Yuan Chen

  5. Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan

    Pin-Yuan Chen

  6. Department of Neurosurgery, New Taipei City Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei, Taiwan

    Kuo-Chen Wei

  7. Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan

    Jian-her Lin

  8. Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan

    Jian-her Lin

  9. Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan

    Jian-her Lin

  10. Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan

    Jian-her Lin

  11. Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan

    Mei-Ru Lin

  12. Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan

    Huan-Chih Wang

  13. Department of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan

    Huan-Chih Wang

  14. Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan

    Hsiao-Yean Chiu

  15. Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Hsiao-Yean Chiu

  16. Department of Psychiatry and Sleep Center, Taipei Medical University Hospital, Taipei, Taiwan

    Hsiao-Yean Chiu

Authors
  1. Pei-Ching Lin
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  5. Mei-Ru Lin
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  7. Hsiao-Yean Chiu
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Contributions

Each author made a substantive intellectual contribution to the study. P-CL, H-YC, and P-YC: conceptualization and study design, data collection, data analysis, data interpretation, manuscript writing, and approval of the final manuscript as submitted. K-CW and J-HL: data collection and interpretation and approval of the final manuscript as submitted. M-RL and H-CW: data collection and approval of the final manuscript as submitted.

Corresponding author

Correspondence to Hsiao-Yean Chiu.

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Conflict of interest

The authors declare no potential conflict of interest regarding the authorship and publication of this article.

Ethical committee permission (includes permission number, if applicable)

This study was approved by the Institutional Review Boards of Taipei Medical University Hospital (no. N201901028), National Taiwan University Hospital (no. 201812054RINB), and Chang Gung Memorial Hospital (no. 202000470B0).

Research involving human participants and/or animals

The study involved human participants and was approved by the ethics committee.

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Written informed consent was obtained from all the participants before study initiation.

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Lin, PC., Chen, PY., Wei, KC. et al. Sleep disturbance in adults with untreated primary brain tumors: prevalence and impact on quality of life. Sleep Biol. Rhythms 21, 201–209 (2023). https://doi.org/10.1007/s41105-022-00436-y

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  • DOI: https://doi.org/10.1007/s41105-022-00436-y

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