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A screening method for sleep disturbances at the end-of-life

Published online by Cambridge University Press:  06 February 2020

Celia Ibáñez del Prado Open the ORCID record for Celia Ibáñez del Prado [Opens in a new window]  and
Juan Antonio Cruzado Open the ORCID record for Juan Antonio Cruzado [Opens in a new window]
Celia Ibáñez del Prado
Affiliation:
Hospital Virgen de la Poveda (SERMAS), Carretera del Hospital km. 5, Villa del Prado, Madrid28630, Spain
Juan Antonio Cruzado*
Affiliation:
Facultad Psicología Universidad Complutense de Madrid, Campus de Somosaguas, Ctra. de Húmera, s/n, Pozuelo de Alarcón, Madrid28223, Spain
*
Author for correspondence: Juan Antonio Cruzado, Facultad Psicología Universidad Complutense de Madrid, Campus de Somosaguas, Ctra. de Húmera, s/n, Pozuelo de Alarcón, Madrid28223, Spain. E-mail: jacruzad@ucm.es
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Abstract

Objective

To evaluate sleep disturbances and to verify the accuracy of three screening tests to detect them in patients at the end-of-life admitted in a hospital palliative care unit.

Method

The level of sleep disturbances was evaluated through the Pittsburgh Sleep Quality Index (PSQI) in 150 palliative patients. This questionnaire was the criterion variable for testing the three screening tests used: Edmonton Symptom Assessment System (ESAS-Sleep subscale); the single question “How much do you worry about your sleep problems?” which is answered on a scale of 0–10 (Sleep-Worry-Q) and another single question: “Do you think you have sleep problems?” with two response categories, Yes/No (Sleep-Problem-Q).

Results

According to the PSQI (cut-off point: 8), 87% of patients presented sleep disturbances. The ESAS-Sleep (cut-off point: 3) showed a sensitivity of 0.87, a specificity of 0.58, and an AUC of 0.729; the Sleep-Worry-Q (cut-off point: 4) showed a sensitivity of 0.95, a specificity of 0.68, and an AUC of 0.854; the Sleep-Problem-Q obtained a sensitivity of 0.92 and a specificity of 0.65.

Significance of results

Patients at the end-of-life, near the time of death, have high levels of sleep disturbances that can be detected early, with better diagnostic accuracy, with the Sleep-Worry-Q. Although from a clinical point of view, the application of the Sleep-Problem-Q may be more advantageous, as it presents good diagnostic accuracy, greater simplicity, and brevity.

Keywords

End-of-lifePalliative careScreening toolSleep disordersSleep disturbances
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Special Issue 4: Palliative and Supportive Care During The COVID-19 Pandemic , August 2020 , pp. 468 - 472
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Copyright
Copyright © Cambridge University Press 2020

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References

REFERENCES

Akechi, T, Okuyama, T, Akizuki, N, et al. (2007) Associated and predictive factors of sleep disturbance in advanced cancer patients. Psycho-Oncology 16(10), 888–894. doi:10.1002/pon.1122CrossRefGoogle ScholarPubMed
Anderson, F, Downing, GM, Hill, J, et al. (1996) Palliative Performance Scale (PPS): A new tool. Journal of Palliative Care 12(1), 5–11.CrossRefGoogle ScholarPubMed
Beck, SL, Schwartz, AL, Towsle, G, et al. (2004) Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. Journal of Pain and Symptom Management 27(2), 140–148. doi:10.1016/j.jpainsymman.2003.12.002CrossRefGoogle ScholarPubMed
Berger, AM, Parker, KP, Young-McCaughan, S, et al. (2005) Sleep wake disturbances in people with cancer and their caregivers: State of the science. Oncology Nursing Forum 32(6), E98–E126. doi:10.1188/05.ONF.E98-E126CrossRefGoogle ScholarPubMed
Bernatchez, MS, Savard, J, Savard, MH, et al. (2017) Sleep-wake difficulties in community-dwelling cancer patients receiving palliative care: Subjective and objective assessment. Palliative & Supportive Care 16(6), 756–766. doi:10.1017/S1478951517000815CrossRefGoogle ScholarPubMed
Bruera, E, Kuehn, N, Miller, MJ, et al. (1991) The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care 7(2), 6–9.CrossRefGoogle ScholarPubMed
Buysse, DJ, Reynolds, CF, Monk, TH, et al. (1989) The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research 28(2), 193–213.CrossRefGoogle ScholarPubMed
Carpenter, JS and Andrykowski, MA (1998) Psychometric evaluation of the Pittsburgh Sleep Quality Index. Journal of Psychosomatic Research 45(1), 5–13.CrossRefGoogle ScholarPubMed
Carvajal, A, Centeno, C, Watson, R, et al. (2011) A comprehensive study of psychometric properties of the Edmonton Symptom Assessment System (ESAS) in Spanish advanced cancer patients. European Journal of Cancer 47(12), 1863–1872. doi:10.1016/j.ejca.2011.03.027CrossRefGoogle Scholar
Centeno, C, Noguera, A, López, B, et al. (2004) Algunos instrumentos de evaluación utilizados en Cuidados Paliativos (I): el cuestionario de evaluación de síntomas de Edmonton (ESAS). Medicina Paliativa 1, 239–245.Google Scholar
Delgado-Guay, M, Yennurajalingam, S, Parsons, H, et al. (2011) Association between self-reported sleep disturbance and other symptoms in patients with advanced cancer. Journal of Pain and Symptom Management 41(5), 819–827. doi:10.1016/j.jpainsymman.2010.07.015CrossRefGoogle ScholarPubMed
Fiorentino, L and Ancoli-Israel, S (2006) Insomnia and its treatment in women with breast cancer. Sleep Medicine Reviews 10(6), 419–429. doi:10.1016/j.smrv.2006.03.005CrossRefGoogle ScholarPubMed
Kvale, E and Shuster, JL (2006) Sleep disturbance in supportive care of cancer: A review. Journal of Palliative Medicine 9(2), 437–450. doi:10.1089/jpm.2006.9.437CrossRefGoogle ScholarPubMed
Mercadante, S, Aielli, F, Adile, C, et al. (2015) Sleep disturbances in patients with advanced cancer in different palliative care settings. Journal of Pain and Symptom Management 50(6), 786–792. doi:10.1016/j.jpainsymman.2015.06.018CrossRefGoogle ScholarPubMed
Mitchell, AJ (2011) Sensitivity × PPV is a recognized test called the clinical utility index (CUI+). European Journal of Epidemiology 26(3), 251–252. doi:10.1007/s10654-011-9561-xCrossRefGoogle Scholar
Montgomery, P and Dennis, J (2002) Bright light therapy for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews 2, CD003403. doi:10.1002/14651858.CD003403.Google Scholar
Morita, T, Tsunoda, J, Inoue, S, et al. (1999) Validity of the Palliative Performance Scale from a survival perspective. Journal of Pain and Symptom Management 18(1), 2–3.Google ScholarPubMed
Mystakidou, K, Parpa, E, Tsilika, E, et al. (2007) Sleep quality in advanced cancer patients. Journal of Psychosomatic Research 62(5), 527–533. doi:10.1016/j.jpsychores.2006.11.008CrossRefGoogle ScholarPubMed
Mystakidou, K, Parpa, E, Tsilika, E, et al. (2009) How is sleep quality affected by the psychological and symptom distress of advanced cancer patients? Palliative Medicine 23(1), 46–53. doi:10.1177/0269216308098088.CrossRefGoogle Scholar
Renom-Guiteras, A, Planas, J, Farriols, C, et al. (2014) Insomnia among patients with advanced disease during admission in a Palliative Care Unit: A prospective observational study on its frequency and association with psychological, physical and environmental factors. BMC Palliative Care 13, 40–52. doi:10.1186/1472-684X-13-40CrossRefGoogle Scholar
Royuela, A and Macías, JA (1997) Propiedades clinimétricas de la versión castellana del cuestionario de Pittsburg. Vigilia y Sueño 9(2), 81–94.Google Scholar
Virik, K and Glare, P (2002) Validation of the palliative performance scale for inpatients admitted to a palliative care unit in Sydney, Australia. Journal of Pain and Symptom Management 23(6), 455–457.CrossRefGoogle ScholarPubMed
Warth, M, Kessler, J and Bardenheue, HJ (2017) Insomnia and autonomic function predict well-being in patients receiving palliative care. Journal of Palliative Medicine 20(12), 1395–1399. doi:10.1089/jpm.2017.0032CrossRefGoogle ScholarPubMed
Yennurajalingam, S, Chisholm, G, Palla, SL, et al. (2015) Self-reported sleep disturbance in patients with advanced cancer: Frequency, intensity, and factors associated with response to outpatient supportive care consultation — A preliminary report. Palliative and Supportive Care 13(2), 135–143. doi:10.1017/S1478951513000850CrossRefGoogle ScholarPubMed
Yennurajalingam, S, Balachandran, D, Pedraza Cardozo, SL, et al. (2017) Patient-reported sleep disturbance in advanced cancer: Frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item. BMJ Supportive & Palliative Care 7(3), 274–280. doi:10.1136/bmjspcare-2015-000847Google ScholarPubMed