Patient-reported sleep disturbance in advanced cancer: Frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item

Sriram Yennurajalingam, Dave Balachandran, Sandra L.Pedraza Cardozo, Elyssa A. Berg, Gary B. Chisholm, Akhila Reddy, Vera De La Cruz, Janet L. Williams, Eduardo Bruera

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Sleep Disturbance (SD) is a severe debilitating symptom in advanced cancer patients (ACP). However, routine screening of SD is uncommon. The primary aim of this study was to determine the optimal cutoff score for SD screening for Edmonton Symptom Assessment system (ESAS) sleep item using Pittsburgh Sleep Quality Index (PSQI) as a gold standard. We also determined the frequency of SD, obstructive sleep apnea symptoms (OSA) and restless leg syndrome (RLS) and factors associated with SD. Methods: We prospectively surveyed 180 consecutive ACP. Patients completed validated assessment for symptoms. We determined epidemiological performance, receiver operating characteristics, and correlations of SD. Results: SD according to PSQI was diagnosed in 112/180 (62%), and median (IQR) ESAS sleep was 5 (2-7). ESAS sleep > 4 had a sensitivity of 74% and 80%, and specificity of 71% and 64% in the training and validation samples, respectively for screening of SD. The frequency of OSA was 61%; RLS was 38%. ESAS sleep was associated [r, p-value] with PSQI (0.61, <0.0001), pain (0.4, <0.0001); fatigue (0.35, <0.0001); depression (0.20, 0.006); anxiety (0.385, <0.0001); drowsiness (0.385, <0.0001), shortness of breath (0.24, <0.0014); anorexia (0.32, <0.0001), well-being (0.36, <0.0001). Multivariate analysis found well-being (OR per point 1.34, p=0.0003), pain (OR 1.21, p<0.0037), dyspnea (OR 1.16, p=0.027), and OSA (OR 0.31, P=0.003) as independent predictors of SD. There was no association between SD and survival. Conclusions: SD is frequent and ESAS SD item > 4 has good sensitivity for SD screening.

Original languageEnglish (US)
Pages (from-to)274-280
Number of pages7
JournalBMJ Supportive and Palliative Care
Volume7
Issue number3
DOIs
StatePublished - Sep 2017
Externally publishedYes

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Oncology(nursing)
  • Medical–Surgical

Fingerprint

Dive into the research topics of 'Patient-reported sleep disturbance in advanced cancer: Frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item'. Together they form a unique fingerprint.

Cite this