TY - JOUR
T1 - Patient-reported sleep disturbance in advanced cancer
T2 - Frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item
AU - Yennurajalingam, Sriram
AU - Balachandran, Dave
AU - Cardozo, Sandra L.Pedraza
AU - Berg, Elyssa A.
AU - Chisholm, Gary B.
AU - Reddy, Akhila
AU - Cruz, Vera De La
AU - Williams, Janet L.
AU - Bruera, Eduardo
N1 - Funding Information:
Funding The corresponding author SY is supported in part by the American Cancer Society (RSG-11–170–01-PCSM). Competing interests None declared. Patient consent Obtained. Provenance and peer review Not commissioned; externally peer reviewed.
PY - 2017/9
Y1 - 2017/9
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85037059503&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85037059503&partnerID=8YFLogxK
U2 - 10.1136/bmjspcare-2015-000847
DO - 10.1136/bmjspcare-2015-000847
M3 - Article
C2 - 26475092
AN - SCOPUS:85037059503
SN - 2045-435X
VL - 7
SP - 274
EP - 280
JO - BMJ Supportive and Palliative Care
JF - BMJ Supportive and Palliative Care
IS - 3
ER -