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Sleep/Wake Patterns of Individuals With Advanced Cancer Measured by Ambulatory Polysomnography

Kathy P. Parker, Donald L. Bliwise, Maria Ribeiro, Sanjay R. Jain, Catherine I. Vena, Mary Kay Kohles-Baker, Andre Rogatko, Zhiheng Xu, Wayne B. Harris

From the Nell Hodgson Woodruff School of Nursing; Department of Neurology; Winship Cancer Institute, Emory University; Veterans Affairs Medical Center, Atlanta, GA; and the Beth Israel Deaconess Medical Center, Harvard University, Boston, MA

Corresponding author: Kathy P. Parker, PhD, RN, AAN, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322-4207; e-mail: kpark04{at}emory.edu

Purpose: Sleep/wake disturbances are prevalent in patients with advanced cancer, but 24-hour polysomnography (PSG) examinations of these patterns have not been undertaken. The purpose of this study was to describe these sleep/wake patterns using continuous PSG and to explore relationships with selected demographic and clinical variables.

Patients and Methods: The sample included patients with advanced cancer (solid tumors); those with neurologic disorders or psychosis, substance abuse, or brain metastasis were excluded. The final sample included 114 participants with a mean age of 51.1 years (± 9.1 years). Participants underwent continuous, ambulatory PSG for 42 hours in their home environments. Standard PSG measures were calculated. Analysis included data from 2 nights and the intervening day. Descriptive statistics were used to summarize sleep/wake parameters of the average of the 2 nights and the intervening day. Nonparametric analyses were used to detect differences and relationships among the variables.

Results: Compared with normative data, participants had reduced quantity and quality of nocturnal sleep and episodes of sleep scattered throughout the day. Increased daytime sleep was negatively associated with several key parameters of nocturnal sleep quantity and quality. Women, whites, and those who were married/partnered and had more education had better nocturnal sleep. Cancer type and selected medications may be risk factors for disturbed sleep and waking.

Conclusion: Participants experienced severe difficulty with "state maintenance", or the ability to maintain both the sleep and waking states. Research designed to identify the etiology of these problems is needed to develop effective interventions.

Supported by Grants No. RO1 NR008124 and P20 NR07798 from the National Institute of Nursing Research.

Presented in part at the 9th Annual Research Conference of the Oncology Nursing Society, February 8-10, 2007, Hollywood, CA; the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA; 41st Annual Meeting of the American Society of Clinical Oncology, May 13-17, 2005, Orlando, FL; and the 19th Annual Meeting of the Associated Professional Sleep Societies, June 18-23, 2005, Denver, CO.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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