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Frequency and characteristics of drowsiness, somnolence, or daytime sleepiness in patients with advanced cancer

Published online by Cambridge University Press:  04 December 2018

Sriram Yennurajalingam ,
Srikanth Reddy Barla ,
Joseph Arthur ,
Gary B. Chisholm  and
Eduardo Bruera
Sriram Yennurajalingam*
Affiliation:
Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Srikanth Reddy Barla
Affiliation:
Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Joseph Arthur
Affiliation:
Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Gary B. Chisholm
Affiliation:
Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
Eduardo Bruera
Affiliation:
Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
*
Author for correspondence: Sriram Yennurajalingam, MD, MS, Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd., Houston, TX 77030. E-mail: syennu@mdanderson.org
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Abstract

Introduction

Cancer-related drowsiness (CRD) is a distressing symptom in advanced cancer patients (ACP). The aim of this study was to determine the frequency and factors associated with severity of CRD. We also evaluated the screening performance of Edmonton Symptom Assessment Scale-drowsiness (ESAS-D) item against the Epworth Sedation Scale (ESS).

Method

We prospectively assessed 180 consecutive ACP at a tertiary cancer hospital. Patients were surveyed using ESAS, ESS, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Hospital Anxiety Depression Scale.

Result

Ninety of 150 evaluable patients had clinically significant CRD (ESS); median (interquartile ratio): ESS. 11 (7–14); ESAS-D. 5 (2–6); Pittsburgh Sleep Quality Index. 8 (5–11); Insomnia Severity Index. 13 (5–19); Stop Bang Scoring 3 (2–4), and Hospital Anxiety Depression Scale-D 6 (3–10). ESAS-D was associated with ESAS (r, p) sleep (0.38, <0.0001); pain (0.3, <0.0001); fatigue (0.51, <0.0001); depression (0.39, <0.0001); anxiety (0.44, <0.0001); shortness of breath (0.32, <0.0001); anorexia (0.36, <0.0001), feeling of well-being [(0.41, <0.0001), ESS (0.24, 0.001), and opioid daily dose (0.19, 0.01). Multivariate-analysis showed ESAS-D was associated with fatigue (odds ratio [OR] = 9.08, p < 0.0001), anxiety (3.0, p = 0.009); feeling of well-being (OR = 2.27, p = 0.04), and insomnia (OR = 2.35; p = 0.036). Insomnia (OR = 2.35; p = 0.036) cutoff score ≥3 (of 10) resulted in a sensitivity of 81% and 32% and specificity of 70% and 44% in the training and validation samples, respectively.

Significance of results

Clinically significant CRD is frequent and seen in 50% of ACP. CRD was associated with severity of insomnia, fatigue, anxiety, and worse feeling of well-being. An ESAS-D score of ≥3 is likely to identify most of the ACP with significant CRD.

Keywords

Daytime sleepinessDrowsinessPalliative careSleep wake disturbancesSomnolenceSupportive Care
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 4 , August 2019 , pp. 459 - 463
Copyright
Copyright © Cambridge University Press 2018 

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References

Atkinson, G and Davenne, D (2007) Relationships between sleep, physical activity and human health. Physiology and Behavior 90(2–3), 229–235.Google Scholar
Baldwin, CM, Griffith, F, Nieto, FJ, et al. (2001). The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep 24(1), 96-105.Google Scholar
Ballon, JS and Feifel, D (2006) A systematic review of modafinil: Potential clinical uses and mechanisms of action. Journal of Clinical Psychiatry 67(4), 554–566.Google Scholar
Bastien, CH, Vallières, A, and Morin, CM (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine 2(4), 297–307.Google Scholar
Bruera, E, Chadwick, S, Brenneis, C, et al. (1987) Methylphenidate associated with narcotics for the treatment of cancer pain. Cancer Treatment Reports 71(1), 67–70.Google Scholar
Bruera, E, Miller, KN, Selmser, MJ, et al. (1991) The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal Palliative Care 7(2), 6–9.Google Scholar
Buxton, OM and Marcelli, E (2010) Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Social Science Medicine 71(5), 1027–1036.Google Scholar
Buysse, DJ, Reynolds, CF, Monk, TH, et al. (1989). The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice. Psychiatry Research 28(2), 193–213.Google Scholar
Chang, VT, Hwang, SS, and Feuerman, M (2000) Validation of the Edmonton Symptom Assessment Scale. Cancer 88(9), 2164–2171.Google Scholar
Cheung, WY, Le, LW, and Zimmermann, C (2009) Symptom clusters in patients with advanced cancers. Support Care Cancer 17(9), 1223–1230.Google Scholar
Chung, F, Yang, Y, Liao, P (2013) Predictive performance of the STOP-Bang Score for identifying obstructive sleep apnea in obese patients. Obesity Surgery 23(12), 2050–2057.Google Scholar
Chung, F, Liao, P, Chung, SA, et al. (2008) STOP questionnaire: A tool to screen patients for obstructive sleep apnea. Anesthesiology 108(5), 812–821.Google Scholar
Cleeland, CS, Mayer, M, Dreyer, NA, et al. (2014) Impact of symptom burden on work-related abilities in patients with locally recurrent or metastatic breast cancer: Results from a substudy of the VIRGO observational cohort study. Breast 23(6), 763–769.Google Scholar
Davidson, JR, MacLean, W, Brundage, MD, et al. (2002) Sleep disturbance in cancer patients. Social Science & Medicine 54(9), 1309–1321.Google Scholar
Degner, LF and Sloan, JA (1995) Symptom distress in newly diagnosed ambulatory cancer patients and as a predictor of survival in lung cancer. Journal of Pain and Symptom Management 10(6), 423–431.Google Scholar
Fan, G, Hadi, S, and Chow, E (2007) Symptom clusters in patients with advanced-stage cancer referred for palliative radiation therapy in an outpatient setting. Supportive Cancer Therapy 4(3), 157–162.Google Scholar
Ferri, R, Lanuzza, B, Cosentino, FII, et al. (2007) A single question for the rapid screening of restless legs syndrome in the neurological clinical practice. European Journal of Neurology 14(9), 1016–1021.Google Scholar
Glare, P, Miller, J, Nikolova, T, et al. (2011) Treating nausea and vomiting in palliative care: A review. Clinical Interventions in Aging 6, 243–259.Google Scholar
Hui, D, Santos, RD, Chisholm, GB, et al. (2015) Symptom expression in the last seven days of life among cancer patients admitted to acute palliative care units. Journal of Pain Symptom and Management 50(4), 488–494.Google Scholar
Hwang, SS, Chang, VT, Rue, M, et al. (2003) Multidimensional independent predictors of cancer-related fatigue. Journal of Pain Symptom and Management 26(1), 604–614.Google Scholar
Johns, MW (1991) A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 14(6), 540–545.Google Scholar
Johns, MW (2000) Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: Failure of the MSLT as a gold standard. Journal of Sleep Research 9(1), 5–11.Google Scholar
Johns, MW (2010) A new perspective on sleepiness. Sleep and Biological Rhythms 8(3), 170–179.Google Scholar
Mastorakos, G, Chrousos, GP, Weber, JS (1993) Recombinant interleukin-6 activates the hypothalamic-pituitary-adrenal axis in humans. Journal of Clinical Endocrinology Metabolism 77(6), 1690–1694.Google Scholar
McClain, J J, Lewin, DS, Laposky, AD, et al. (2014) Associations between physical activity, sedentary time, sleep duration and daytime sleepiness in US adults. Preventive Medicine 66, 68–73.Google Scholar
Mercadante, S, Casuccio, A ,and Fulfaro, F (2000) The course of symptom frequency and intensity in advanced cancer patients followed at home. Journal of Pain and Symptom Management 20(2), 104–112.Google Scholar
Paiva, CE, Manfredini, LL, Paiva, BS, et al. (2015) The Brazilian version of the Edmonton Symptom Assessment System (ESAS) is a feasible, valid and reliable instrument for the measurement of symptoms in advanced cancer patients. PLoS One 10(7), e0132073.Google Scholar
Papanicolaou, DA, Tsigos, C, Oldfield, EH, et al. (1996) Acute glucocorticoid deficiency is associated with plasma elevations of interleukin-6: Does the latter participate in the symptomatology of the steroid withdrawal syndrome and adrenal insufficiency? Journal of Clinical Endocrinology Metabolism 81(6), 2303–2306.Google Scholar
Parker, KP, Bliwise, DL, Ribeiro, M, et al. (2008) Sleep/wake patterns of individuals with advanced cancer measured by ambulatory polysomnography. Journal of Clinical Oncology 26(15), 2464–2472.Google Scholar
Patel, SR and Hu, FB (2008) Short sleep duration and weight gain: A systematic review. Obesity (Silver Spring) 16(3), 643–653.Google Scholar
Rao, KV and Faso, A (2012) Chemotherapy-induced nausea and vomiting: Optimizing prevention and management. American Health & Drug Benefits 5(4), 232–240.Google Scholar
Ripamonti, C and Bruera, E (1997) CNS adverse effects of opioids in cancer patients. CNS Drugs 8(1), 21–37.Google Scholar
Roscoe, JA, Kaufman, ME, Matteson-Rusby, SE, et al. (2007) Cancer-related fatigue and sleep disorders. Oncologist 12(Suppl 1), 35–42.Google Scholar
Sanford, SD, Zhao, F, Salsman, JM, et al. (2014) Symptom burden among young adults with breast or colorectal cancer. Cancer 120(15), 2255–2263.Google Scholar
Schwartz, JRL, Roth, T, Hirshkowitz, M, et al. (2009) Recognition and management of excessive sleepiness in the primary care setting. Primary Care Companion to The Journal of Clinical Psychiatry 11(5), 197–204.Google Scholar
Valentino, RM and Foldvary-Schaefer, N (2007) Modafinil in the treatment of excessive daytime sleepiness. Cleveland Clinic Journal of Medicine 74(8), 561–571.Google Scholar
Vgontzas, AN, Papanicolaou, DA, Bixler, EO, et al. (1997) Elevation of plasma cytokines in disorders of excessive daytime sleepiness: Role of sleep disturbance and obesity. Journal of Clinical Endocrinology Metabolism 82(5), 1313–1316.Google Scholar
Vgontzas, AN, Pejovic, S, Zoumakis, E, et al. (2007) Daytime napping after a night of sleep loss decreases sleepiness, improves performance, and causes beneficial changes in cortisol and interleukin-6 secretion. American Journal of Physiology Endocrinology Metabolism 292(1), E253–E261.Google Scholar
Wilwerding, MB, Loprinzi, CL, Mailliard, J A, et al. (1995) A randomized, crossover evaluation of methylphenidate in cancer patients receiving strong narcotics. Support Care Cancer 3(2), 135–138.Google Scholar
Wochna Loerzel, V (2015) Symptom experience in older adults undergoing treatment for cancer. Oncology Nursing Forum 42(3), E269–E278.Google Scholar
Yennurajalingam, S, Balachandran, D, Pedraza Cardozo, SL, et al. (2015) Patient-reported sleep disturbance in advanced cancer: Frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item. British Medical Journal of Supportive Palliative Care 7(3), 274–280.Google Scholar
Zigmond, AS and Snaith, RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67(6), 361–370.Google Scholar
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