Sleep quality in hospitalized patients with advanced cancer: an observational study using self-reports of sleep and actigraphy
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Although patients with advanced cancer report poor sleep quality, few studies have assessed sleep quality with a combination of subjective and objective measures. We aimed to examine sleep quality in hospitalized patients with advanced cancer by combining patient-reported outcome-measures (PROMs) and polysomnography (PSG) or actigraphy.
A one-night prospective observational study of sleep in hospitalized patients with metastatic cancer using WHO step III opioids was conducted. Total sleep time, sleep onset latency, number of awakenings, and wake after sleep onset were assessed by PROMs and actigraphy. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) (range; 0–21), where higher scores indicate worse sleep quality.
Forty patients were monitored. Median age was 70, median oral morphine equivalent dose was 80 mg/24 h (10–1725), median Karnofsky Performance Score was 50 (20–90), and median time to death from inclusion was 38 days (4–319). Mean PSQI score was 6.5 (SD ± 3.4). PROMs and actigraphy of mean (SD) sleep onset latency were 46 (± 64) and 35 min (± 61), respectively, while mean time awake at night was 37 (± 35) and 40 min (± 21). PROMs and actigraphy differed on number of awakenings (mean 2 (± 1) vs. 24 (± 15), p ˂ 0.001). Bland-Altman plots showed large individual differences between PROMs and actigraphy. PSG was not feasible.
PROMs and actigraphy documented poor sleep quality, but a lack of agreement across methods. The study demonstrates a need to improve assessment of sleep quality and treatment of sleep disturbance in hospitalized patients with advanced cancer near end of life.
KeywordsSleep Advanced cancer Sleep diary Actigraphy Polysomnography
We would like to thank all participating patients. In addition, we would like to thank the Department of Palliative Medicine, Cancer Clinic, St. Olav’s hospital, Trondheim University Hospital, Trondheim, Norway, for important contribution to patient recruitment and completion of the study. We thank Ragnhild Green Helgås for language editing.
This work was funded by grants from the Central Norway Regional Health Authority awarded by the Liaison Committee for Central Norway (Project number 46083200, year 2015). The funder had no role in the trial design, collection, analysis and interpretation of data, or writing.
Compliance with ethical standards
Conflict of interest
Gunnhild Jakobsen, Morten Engstrøm, Morten Thronæs, Erik Torbjørn Løhre, Peter Fayers, Marianne Jensen Hjermstad, and Pål Klepstad have nothing to disclosure. Stein Kaasa is one of the shareholders in Eir Solution A/S and has research funding from Nutricia for other studies. He declares no income, dividend, or financial benefits from the work presented here.
The study was conducted in accordance with ethical principles in the Declaration of Helsinki and was consistent with ICH/Good Clinical Practice and applicable regulatory requirements. The Regional Committee for Medical and Health Research Ethics, Rec North, approved the study (approval number 2015/1631).
Informed consent was obtained from all individual participants included in the study.
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