|
 
 |
| REVIEW ARTICLE |
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| Year : 2020 | Volume
: 2
| Issue : 4 | Page : 153-159 |
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Sleep disturbance in patients with cancer
Mohammed Al Maqbali
Department of Nursing, Al Buraimi Hospital, Ministry of Health, Al Buraimi, Oman
| Date of Submission | 10-Jul-2020 |
| Date of Decision | 10-Aug-2020 |
| Date of Acceptance | 18-Aug-2020 |
| Date of Web Publication | 25-Dec-2020 |
Correspondence Address:
Dr. Mohammed Al Maqbali
Al Buraimi Hospital, Ministry of Health, Al Buraimi
Oman
 Source of Support: None, Conflict of Interest: None  | 1 |
DOI: 10.4103/jin.jin_48_20
Patients diagnosed with cancer often experience sleep disturbance in the form of poor sleep patterns or insomnia that can start on diagnosis and continue until the end of the individual's life. The aim of this review is to discuss current definitions and theories of sleep disturbance, its prevalence, the underlying physiological and psychological correlates, measurement scales, and possible intervention and management strateg?ies. Equally important, regular assessment is worthwhile for sleep disturbance and quality of life among cancer patients. Therefore, it is advisable for health-care professionals to conduct regular assessment of sleep disturbance for cancer patients and provide appropriate management.
Keywords: Definition, etiology, prevalence, risk factors, scale, sleep disturbance
How to cite this article:
Al Maqbali M. Sleep disturbance in patients with cancer. J Integr Nurs 2020;2:153-9 |
| Introduction | |  |
Diagnosis of cancer is a major life stressor that can affect the physiological, psychological, and physical state of a person. The cancer journey can involve pain, weakness, sleep problems, and fatigue, and may cause limited function in terms of active daily living. People with cancer may experience symptoms related to their treatment and/or disease type and stage. One of the most common and distressing symptoms is sleep disturbance, which negatively affects the quality of life.[1] Patients diagnosed with cancer often experience sleep disturbance, especially insomnia. Sleep disturbance among cancer patients is a familiar problem and can start with the diagnosis and continue to the end of the patient's life.[2],[3]
This review will discuss the current definitions and theories of sleep disturbance, its prevalence, the underlying physiological and psychological correlates, measurement scales, and possible intervention and management strategies.
| Definitions of Sleep Disturbance | | |
There are potential difficulties in defining sleep disturbance or disorder, as sleep quality is a multidimensional concept. Buysse[4] defines sleep health as, “a multidimensional pattern of sleep-wakefulness, adapted to individual, social, and environmental demands, that promotes physical and mental well-being.?” Good sleep health is characterized by subjective satisfaction, appropriate timing, adequate duration, high efficiency, and sustained alertness during waking hours.
The National Institute of Health[5] defines sleep disturbance as, “dysregulation of sleep homeostasis, sleep deficiency, sleep fragmentation, insufficient sleep or impairment of sleep quality or quantity caused by a sleep disorder.” Specifically, sleep disturbance may include difficulty falling asleep, problems with the initiation and maintenance of sleep, poor sleep timing, quality, efficiency, and excessive daytime sleepiness.[6],[7],[8]
The International Classification of Sleep Disorder-3 divides sleep symptoms into the following three diagnostic sections: insomnia, sleepiness, or abnormal events during sleep.[9] Insomnia is a sleep disturbance symptom that has been excessively used in the literature to describe sleep symptoms among patients diagnosed with cancer. Roth et al.[10] defined insomnia as difficulty initiating or maintaining sleep or nonrestorative sleep; it is also associated with daytime distress or impairment.
Difficulty sleeping is a phrase regularly used by patients to describe their sleep. The major challenge facing the researcher is to verify what this means and how to measure it. The following nine parameters of sleep disturbance have been recommended to measure sleep problems: total sleep time, sleep latency, awakenings, wake time after sleep sunset, napping during the day, excessive daytime sleepiness, quality of perceived sleep, stability of circadian rhythms, and sleep efficiency.[11] Adult parameters of sleep disturbance include sleeping for <7 h, sleep latency of >20 min, awakening >7 times during the night, waking after sleep onset >10% of the time, napping during the daytime for >2 h, minimal opportunities for daytime sleepiness while engaging with routine activities, satisfaction with the quality of perceived sleep, circadian rhythms within a 27 h period, and <80% sleep efficiency indicating a bad night.[6]
Sleep disturbance, thus, is a multidimensional concept that is, accordingly, measured across multiple aspects or dimensions. Understanding the differences between normal sleep and poor sleep can help health-care professionals in designing interventions to improve sleep, through a comprehensive care plan that meets the needs of patients with cancer. Defining sleep disturbance will, thus, guide the researcher and promote the health of such patients.
| Prevalence of Sleep Disturbance | | |
Sleep disturbance is reported to be the second most common symptom among cancer patients.[12] Identifying the prevalence of sleep disturbance is important in understanding the underlying problem and developing treatment or a particular intervention for patients with cancer. A systematic review by Otte et al.[13] found that the prevalence for specific types of sleep disturbance in cancer remains unclear.
Sleep disturbance prevalence, type, and severity are difficult to assess in patients diagnosed with cancer, with incidences ranging from 50%[11] to 88%.[14] This is approximately three times higher than the rate within the general population.[15] Differences in prevalence among cancer patient populations may be partially dependent on cancer types, stages, and time of measurement such as pre- or post-chemotherapy/pre- or post-radiotherapy.
In a recent study, Akman et al.[16] examined the prevalence of sleep disturbance in 314 patients with different types of cancer; these researchers found 40.4% of patients suffered from poor quality sleep. An integrative review of 27 studies evaluating sleep quality in women with breast cancer found that the prevalence of sleep disturbance ranged from 65% to 87%.[17] In a large population-based study, Voiss et al.[18] reported sleep problems from the 2017 US National Health Interview Survey of 23,222,976 cancer survivors and found that 59.2% reported sleep problem. Al Maqbali et al.[19] conducted a cross-sectional study to identify sleep disturbance in 369 cancer survivors and found that the prevalence of poorer sleep among participants was 78%. A prospective study of 73 patients with breast cancer reported that 97% of patients experienced poor-quality sleep.[20]
Different types of cancer can lead to different percentages of patients experiencing sleep disturbance; for example, thyroid, 54.32%;[21] lung, 93.1%;[22] head and neck, 83%;[23] leukemia, 67.5%;[24] and melanoma, 60.7%.[25] Savard et al.[26] conducted a longitudinal study of patients with breast (n = 465) and prostate (n = 263) cancer to evaluate the relationship between adjuvant treatment and insomnia. They found that for breast cancer patients, insomnia was 66.2% at baseline, 51% at 6 months, and 38.8% at 18 months, whereas for prostate cancer patients, insomnia was 36.9% at baseline, 29% at 6 months, and 25% at 18 months.
Sleep disturbance may occur during the treatment of cancer, before and after surgical interventions, during radiotherapy and/or chemotherapy, and even after completing treatment. A longitudinal study by Halle et al.[27] explored sleep disturbance in 264 lung cancer patients who had undergone surgery and found that sleep disturbance was 60.9% at baseline, 68.5% at 1 month, 55.4% at 5 months, and 49.7% at 9 months.
Hong et al.[28] assessed sleep disturbance every 4th week during chemotherapy treatment for 706 patients with mixed types of cancer. They found that sleep quality was 51.86% at baseline and 68.54%, 83.48%, 89.36%, and 96.43% every 4th week, showing an increase in sleep disturbance during chemotherapy treatment. An observational study conducted by Tian et al.[29] involving 76 cervical cancer patients undergoing chemotherapy found that sleep quality was 61.84% before and 64.50% after adjuvant therapy.
Radiotherapy is a primary form of treatment for cancer patients. A prospective study by Mo et al.[30] investigated sleep changes before and after radiotherapy for 51 nasopharyngeal cancer patients; the results showed that 37.3% of patients had poor sleep quality before starting radiotherapy, which increased to 64.7% after radiotherapy. Similarly, a longitudinal study of eighty breast cancer patients found that poor sleep before, during, and after radiotherapy was 61%, 56%, and 59%, respectively.[31]
Sleep disturbance may increase even after completing treatment. For instance, Lowery-Allison et al.'s[32] study of breast cancer survivors, 1–10 years posttreatment, found that 38% (76 out of 200) of patients experienced poor quality sleep. Findings from a cross-sectional survey of 337 cancer survivors by Ness et al.[33] found that 50% of participants reported sleep disturbance.
A systematic review of 254 studies by Otte et al.[13] found that the prevalence of sleep disorders could not be ascertained from research on patients with cancer. This was primarily due to the conceptualization and operationalization of “poor sleep,” as the studies used different terminology that did not fully assess sleep disorder; thus, most of the studies (89.8%; 228) did not define sleep disorders. A cross-sectional study in South Korea by Park et al.,[34] of 30,400 patients diagnosed with cancer, found the prevalence of insomnia to be 8.21%; this was highest among lung cancer patients. However, the study did not use an instrument to measure insomnia, which means the percentage only reflects patients diagnosed with insomnia. Sleep disturbance can be assessed using objective measures and through self-reports. Wrist actigraphy is one such objective measure; however, many researchers have used a self-report instrument to measure sleep disturbance. The different findings between the studies reported above could be due to the variety of assessment methods used.
Consequently, understating the level of poor sleep among patients with cancer before, during, and after treatment is an important research area that will help in the development of an intervention for specific types of cancer and different stages of the cancer patient journey. However, as this review of the literature shows, it is important to use a valid and standard method of assessing “poor sleep”.
| Impact of Sleep Disturbance | | |
Sleep disorders are reported to be associated with decreased quality of life, increased use of health-care resources, and poor mood. Sleep disturbance has also been linked with the likelihood of cancer recurrence[35],[36] and may result in poor healing,[13] decreased cognitive functioning,[37] and reduced work activity.[38]
Evidence of sleep disturbance impact is provided by surveys from the USA and five European countries, which found that people with insomnia experienced significantly worse health-related quality of life compared to people with normal sleep.[39] Sleep disturbance can cause changes in metabolism,[40] immune pathways,[41] and endocrine functioning.[42] Similarly, sleep disturbance in cancer patients can have a negative impact on health-related quality of life, which includes physical and psychological functioning.[43],[44]
Research indicates that sleep disorders or poor sleep can have other negative effects on health, insofar as it can significantly increase the risk of developing Type 2 diabetes[45] and hypertension[46] and increase the risk of cardiovascular disease.[47] However, it is important to note that the consequences of sleep disorders are not confined to the individual; they may also have implications at a societal level in terms of public health and economic burdens.[48]
| Etiology and Influencial Factors of Sleep Disturbance | | |
Sleep disturbance in patients with cancer may be attributable to the physiological and psychological effects of the cancer and the effects of treatment, surgery, chemotherapy, radiotherapy, and medications. Thus, it is difficult to establish the etiology of sleep disturbance.
In terms of demographic factors, being female, older age, having a lower level of education, and engaging in less physical activity have all been linked to sleep disturbance.[49],[50],[51] In a cross-sectional study of 209 mixed cancer patients, Akechi et al.[52] found a significant relationship between sleep disturbance and younger age, marital status (unmarried), living alone, higher psychological distress, pain, and diarrhea. However, the age relationship may be influenced by other factors that could increase sleep disturbance. For instance, Coles et al.[53] found that pain, anxiety, fatigue, and multiple comorbid conditions were significantly associated with worsening sleep disturbance among colorectal cancer patients. Galiano-Castillo et al.[54] also found a significant relationship between insomnia and types of treatment, depression, and anxiety among breast cancer patients.
In the context of cancer, tumor type and the treatments used may influence sleep disturbance. For example, Savard et al.[55] conducted a longitudinal study of 962 mixed patients over 18 months and found a significant association between insomnia and different types of cancer, including breast, prostate, gynecologic, urinary, and gastro-intestinal cancer. Furthermore, studies conducted on cancer patients to assess treatment efficacy found that chemotherapy[56] and radiotherapy[57] were significantly associated with an increase in sleep disturbance.
Furthermore, chemotherapy and radiotherapy have been associated with an increase in sleep disturbance and the level of pro-inflammatory cytokine markers such as interleukin (IL)-1β and IL-6 and tumor necrosis factor-α.[58],[59],[60] Current evidence shows that immune mediators are released as a response to pathogen invasion tissue injury or cytotoxic factors.[61] Even though some studies have found a relationship between cytokine markers and sleep disturbance, this is still not fully understood and further research is required in this area. Cancer-induced changes in metabolism, immunity, or endocrine function likely disrupt sleep via the promotion of aberrant activity within some neural populations.[62]
Overall, research findings suggest that sleep disturbance is associated with several different factors, but these factors will change from patient to patient. Further research should, therefore, explore these factors to facilitate their appropriate management and develop a strategy to prevent or reduce sleep disturbance.
| Measurement of Sleep Disturbance | | |
Sleep disturbance can be assessed either objectively or subjectively. The two most common objective measurements for patients with cancer are polysomnography (PSG) and actigraphy, whereas the following three subjective scales have been used and validated in cancer populations: the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scales (ESS), and the Insomnia Severity Index (ISI). However, each of the assessment methods has both advantages and disadvantages.
Objective measures
PSG is the gold standard for recording sleep.[63],[64] The components of PSG consist of electroencephalography, electrocardiogram, electrooculography, electromyography, arterial oxygen saturation, respiratory effort, oral and nasal airflow, body position, and limb movement.[65] The data derived from PSG involve sleep latency, wake after sleep onset time, total sleep time, and sleep efficiency. However, PSG is expensive and does not provide information about sleep habits at home.
Actigraphy involves wearing a wrist device that measures movement activity between sleep and awake states.[66] The advantages of actigraphy are that it is easy to use, it is cheaper than PSG, and it can record for 24 h for a month.
Subjective measures
The PSQI is a 19-item scale designed to measure different aspects of sleep quality and sleep disturbance.[67] The scale reports the sleep quality of the previous month. The PSQI is divided into seven subscale scores, namely, subjective sleep quality, sleep latency (time to full sleep), duration, habitual sleep efficiency (proportion between total sleep time and time in bed), sleep disturbances (waking up during the night), use of sleeping medication, and daytime dysfunction (difficulty staying awake during daytime). The overall score ranges between 0 and 21; the high score indicates poor sleep quality. The original PSQI was tested on both psychiatric patients and a healthy sample; however, it has been validated in different clinical populations. Two studies have validated the PSQI in patients with cancer and showed internal consistency (Cronbach's alpha = 0.89).[68],[69]
The ESS was constructed to assess daytime sleepiness and diagnose sleep disorders across eight items in a 4-point Likert scale.[70] The total score ranges between 0 (normal sleep) and 24 (very sleepy).
The ISI has seven items on a 5-point Likert scale; it has three subscales assessing the nature, severity, and impact of insomnia.[71] The scale measures the interval in the last 2 weeks. The overall score ranges between 0 and 28; the higher score indicates more severe insomnia. The total score can be categorized as follows: 0–7 (absence of insomnia); 8–14 (subthreshold insomnia); 15–24 (moderate insomnia); and 22–28 (severe insomnia).
All subjective measures are easy to administer and cheap, however they cannot roll out the subjective recall biases.[72] Consideration should be given when choosing an appropriate instrument of measuring sleep quality for research or clinical proposes, as each objective or subjective measure has advantages and disadvantages.
| Management of Sleep Disturbance | | |
The management of sleep disturbance has involved a range of interventions that can be divided into pharmacological and nonpharmacological approaches. Several studies have investigated the effectiveness of nonpharmacological interventions on sleep disturbance in cancer patients, whereas no pharmacological interventions have been included in studies involving cancer patients. For example, cognitive behavioral interventions (CBIs) have had significant effects on reducing sleep disturbance, with several reviews recommending their use.[73],[74] CBIs include sleep hygiene, stimulator control, relaxation therapies, sleep restriction, and cognitive restructuring. In a meta-analysis of nine studies, Johnson et al.[74] found that CBIs lead to reductions in insomnia, sleep-onset latency, and improved sleep efficiency in cancer survivors. A randomized controlled trial of 248 patients with breast cancer was undertaken by Savard et al.[75] who found that CBIs had a significant effect on insomnia at a 12-month follow-up.
In a study by Reich et al.[76] involving 320 breast cancer patients, a mindfulness-based stress reduction (MBSR) was applied for 12 weeks; it had a significant effect on sleep quality. This result was supported by a randomized controlled trial evaluating the effectiveness of MBSR among breast and colorectal cancer patients, which also showed a significant reduction in sleep disturbance.[77],[78]
Other mind–body practices focusing on the interaction between the brain, mind, body, and behavior, have demonstrated an improvement in sleep disturbance, such as yoga;[79] warm shower or baths;[80] acupuncture;[81] Qi Gong/Tai Chi;[82] and massage.[83]
Exercise interventions to reduce sleep disturbance among cancer patients have been undertaken and reported in several reviews. However, the evidence was inconclusive due to biases in several studies. In a recent systematic review and meta-analysis of 17 randomized controlled trials (RCTs) and four non-RCTs involving a total of 1595 participants, Mercier et al.[84] concluded that exercise interventions have no significant effect on sleep outcomes in patients with cancer. However, in comparison, a systematic review by Chiu et al.[85] of nine RCTs involving 599 patients found a modest effect of walking exercise on reducing sleep disturbance.
A number of clinical practice guidelines have been published for pharmacological management of the general population. For example, the American Academy of Sleep Medicine (AASM) conducted a meta-analysis of 46 studies and found weak evidence to support the use of 14 agents (suvorexant, eszopiclone, zaleplon, zolpidem, triazolam, temazepam, ramelteon, doxepin, trazodone, tiagabine, diphenhydramine, melatonin, tryptophan, and valerian).[86] The AASM guidelines concluded that these agents are not recommended for the treatment of chronic insomnia in adults.
To conclude, the Oncology Nursing Society published guidelines that critically appraised evidence for the safety and efficacy of using pharmacological and nonpharmacological interventions to reduce sleep disturbance in patients with cancer.[87] The guidelines found sufficient evidence to use CBIs, while MBSR and exercise intervention were likely to be effective, but required further research. Research on pharmacological interventions in cancer populations has yet to be conducted.
| Conclusion | | |
Sleep disturbance is a multidimensional concept whose prevalence and severity is higher among patients with cancer. The impact of sleep disturbance has been linked to the recurrence of cancer and a reduced life span among cancer survivors. This review has provided important evidence for measuring and managing sleep disturbance that can help in understanding sleep disturbance among cancer patients. Assessing sleep disturbance should be routine in clinical settings, thus identifying proper interventions, treatment, and management to improve sleep quality among cancer patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Wu HS, Harden JK. Symptom burden and quality of life in survivorship: A review of the literature. Cancer Nurs 2015;38:E29-54.  |
| 2. | Berger AM. Update on the state of the science: Sleep-wake disturbances in adult patients with cancer. Oncol Nurs Forum 2009;36:E165-77. |
| 3. | Otte JL, Carpenter JS, Russell KM, et al. Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors. J Pain Symptom Manage 2010;39:535-47. |
| 4. | Buysse DJ. Sleep health: Can we define it? Does it matter? Sleep 2014;37:9-17. |
| 5. | National Institutes of Health. National Institutes of Health Sleep Disorders Research Plan. Maryland, USA: National Institutes of Health; 2011. p. 1-34. |
| 6. | Berger AM, Matthews EE, Aloia MS. Sleep and cancer. In: Olver I, editor. MASCC Textb Cancer Support Care Surviv. Cham: Springer International Publishing; 2018. p. 53-65. |
| 7. | Otte JL, Davis L, Carpenter JS, et al. Sleep disorders in breast cancer survivors. Support Care Cancer 2016;24:4197-205. |
| 8. | Sateia MJ. International classification of sleep disorders-third edition: Highlights and modifications. Chest 2014;146:1387-94. |
| 9. | American Academy of Sleep Medicine. International classification of sleep disorders–third edition (ICSD-3). 3 rd ed. Darien, IL: American Academy of Sleep Medicine; 2014. |
| 10. | Roth T, Coulouvrat C, Hajak G, et al. Prevalence and perceived health associated with insomnia based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition criteria: Results from the America Insomnia Survey. Biol Psychiatry 2011;69:592-600. |
| 11. | Berger AM, Parker KP, Young-McCaughan S, et al. Sleep wake disturbances in people with cancer and their caregivers: State of the science. Oncol Nurs Forum 2005;32:E98-126. |
| 12. | Cleeland CS, Zhao F, Chang VT, et al. The symptom burden of cancer: Evidence for a core set of cancer-related and treatment-related symptoms from the Eastern Cooperative Oncology Group Symptom Outcomes and Practice Patterns study. Cancer 2013;119:4333-40. |
| 13. | Otte JL, Carpenter JS, Manchanda S, et al. Systematic review of sleep disorders in cancer patients: Can the prevalence of sleep disorders be ascertained? Cancer Med 2015;4:183-200. |
| 14. | Clark J, Cunningham M, McMillan S, et al. Sleep-wake disturbances in people with cancer part II: Evaluating the evidence for clinical decision making. Oncol Nurs Forum 2004;31:747-71. |
| 15. | Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: The HypnoLaus study. Lancet Respir Med 2015;3:310-8. |
| 16. | Akman T, Yavuzsen T, Sevgen Z, et al. Evaluation of sleep disorders in cancer patients based on Pittsburgh Sleep Quality Index. Eur J Cancer Care (Engl) 2015;24:553-9. |
| 17. | Mansano-Schlosser TC, Ceolim MF, Valerio TD. Sleep quality in women with breast cancer: An integrative review. Int Arch Med 2016;9:1-17. |
| 18. | Voiss P, Höxtermann MD, Dobos G, et al. Cancer, sleep problems, and mind-body medicine use: Results of the 2017 National Health Interview Survey. Cancer 2019;125:4490-7. |
| 19. | Al Maqbali M, Hughes C, Rankin J, et al. Fatigue and sleep disturbance in Arabic cancer patients after completion of therapy: Prevalence, correlates, and association with quality of life. Cancer Nurs 2020; https://doi.org/10.1097/ncc.0000000000000825. |
| 20. | Dhruva A, Paul SM, Cooper BA, et al. A longitudinal study of measures of objective and subjective sleep disturbance in patients with breast cancer before, during, and after radiation therapy. J Pain Symptom Manage 2012;44:215-28. |
| 21. | He Y, Meng Z, Jia Q, et al. Sleep quality of patients with differentiated thyroid cancer. PLoS One 2015;10:e0130634. |
| 22. | Lin S, Chen Y, Yang L, et al. Pain, fatigue, disturbed sleep and distress comprised a symptom cluster that related to quality of life and functional status of lung cancer surgery patients. J Clin Nurs 2013;22:1281-90. |
| 23. | Li N, Otomaru T, Taniguchi H. Sleep quality in long-term survivors of head and neck cancer: Preliminary findings. Support Care Cancer 2017;25:3741-8. |
| 24. | Miladinia M, Baraz S, Ramezani M, et al. The relationship between pain, fatigue, sleep disorders and quality of life in adult patients with acute leukaemia: During the first year after diagnosis. Eur J Cancer Care (Engl) 2018;27:e12762. https://doi.org/10.1111/ecc.12762. |
| 25. | Martinez-Garcia MA, Martorell A, Nagore E, et al. Relationship Between Sleep-Disordered Breathing And Aggressiveness Markers Of Malignant Cutaneous Melanoma. A Multicentric Study. B99 Best Everything Hot Top Sleep. American Thoracic Society; 2016. p. A4323. |
| 26. | Savard J, Ivers H, Savard MH, et al. Cancer treatments and their side effects are associated with aggravation of insomnia: Results of a longitudinal study. Cancer 2015;121:1703-11. |
| 27. | Halle IH, Westgaard TK, Wahba A, et al. Trajectory of sleep disturbances in patients undergoing lung cancer surgery: A prospective study. Interact Cardiovasc Thorac Surg 2017;25:285-91. |
| 28. | Hong JS, Tian J, Wu LH. The influence of chemotherapy-induced neurotoxicity on psychological distress and sleep disturbance in cancer patients. Curr Oncol 2014;21:174-80. |
| 29. | Tian J, Chen GL, Zhang HR. Sleep status of cervical cancer patients and predictors of poor sleep quality during adjuvant therapy. Support Care Cancer 2015;23:1401-8. |
| 30. | Mo YL, Li L, Qin L, et al. Cognitive function, mood, and sleep quality in patients treated with intensity-modulated radiation therapy for nasopharyngeal cancer: A prospective study. Psychooncology 2014;23:1185-91. |
| 31. | Hanasoge S, Wang X, Chen Z, et al. The influence of radiotherapy on sleep disturbances in breast cancer patients. J Clin Oncol 2014;32:1092-2. |
| 32. | Lowery-Allison AE, Passik SD, Cribbet MR, et al. Sleep problems in breast cancer survivors 1-10 years posttreatment. Palliat Support Care 2018;16:325-34. |
| 33. | Ness S, Kokal J, Fee-Schroeder K, et al. Concerns across the survivorship trajectory: Results from a survey of cancer survivors. Oncol Nurs Forum 2013;40:35-42. |
| 34. | Park B, Youn S, Hann CW, et al. Prevalence of insomnia among patients with the ten most common cancers in South Korea: Health insurance review and assessment service-national patient sample. Sleep Med Res 2016;7:48-54. |
| 35. | Sigurdardottir LG, Valdimarsdottir UA, Mucci LA, et al. Sleep disruption among older men and risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 2013;22:872-9. |
| 36. | Thompson CL, Li L. Association of sleep duration and breast cancer OncotypeDX recurrence score. Breast Cancer Res Treat 2012;134:1291-5. |
| 37. | Schagen SB, Klein M, Reijneveld JC, et al. Monitoring and optimising cognitive function in cancer patients: Present knowledge and future directions. EJC Suppl 2014;12:29-40. |
| 38. | Die Trill M. Anxiety and sleep disorders in cancer patients. EJC Suppl 2013;11:216-24. |
| 39. | DiBonaventura M, Richard L, Kumar M, et al. The association between insomnia and insomnia treatment side effects on health status, work productivity, and healthcare resource use. PLoS One 2015;10:e0137117. |
| 40. | Zimberg IZ, Dâmaso A, Del Re M, et al. Short sleep duration and obesity: Mechanisms and future perspectives. Cell Biochem Funct 2012;30:524-9. |
| 41. | Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch 2012;463:121-37. |
| 42. | Morgan D, Tsai SC. Sleep and the endocrine system. Crit Care Clin 2015;31:403-18. |
| 43. | Palesh OG, Roscoe JA, Mustian KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol 2010;28:292-8. |
| 44. | Rolke HB, Bakke PS, Gallefoss F. HRQoL changes, mood disorders and satisfaction after treatment in an unselected population of patients with lung cancer. Clin Respir J 2010;4:168-75. |
| 45. | Holliday EG, Magee CA, Kritharides L, et al. Short sleep duration is associated with risk of future diabetes but not cardiovascular disease: A prospective study and meta-analysis. PLOS ONE 2013;8:e82305. |
| 46. | Anothaisintawee T, Reutrakul S, Van Cauter E, et al. Sleep disturbances compared to traditional risk factors for diabetes development: Systematic review and meta-analysis. Sleep Med Rev 2016;30:11-24. |
| 47. | Khan MS, Aouad R. The effects of insomnia and sleep loss on cardiovascular disease. Sleep Med Clin 2017;12:167-77. |
| 48. | Colten HR, Altevogt BM. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, D.C.: The National Academies Press; 2006. |
| 49. | Colagiuri B, Christensen S, Jensen AB, et al. Prevalence and predictors of sleep difficulty in a national cohort of women with primary breast cancer three to four months postsurgery. J Pain Symptom Manage 2011;42:710-20. |
| 50. | Morris BA, Thorndike FP, Ritterband LM, et al. Sleep disturbance in cancer patients and caregivers who contact telephone-based help services. Support Care Cancer 2015;23:1113-20. |
| 51. | Nelson AM, Jim HS, Small BJ, et al. Sleep disruption among cancer patients following autologous hematopoietic cell transplantation. Bone Marrow Transplant 2018;53:307-14. |
| 52. | Akechi T, Okuyama T, Akizuki N, et al. Associated and predictive factors of sleep disturbance in advanced cancer patients. Psychooncology 2007;16:888-94. |
| 53. | Coles T, Tan X, Bennett AV, et al. Sleep quality in individuals diagnosed with colorectal cancer: Factors associated with sleep disturbance as patients transition off treatment. Psychooncology 2018;27:1050-6. |
| 54. | Galiano-Castillo N, Arroyo-Morales M, Ariza-Garcia A, et al. Factors that explain the cancer-related insomnia. Breast J 2017;23:387-94. |
| 55. | Savard J, Ivers H, Villa J, et al. Natural course of insomnia comorbid with cancer: An 18-month longitudinal study. J Clin Oncol 2011;29:3580-6. |
| 56. | Hsu HT, Lin KC, Wu LM, et al. Symptom cluster trajectories during chemotherapy in breast cancer outpatients. J Pain Symptom Manage 2017;53:1017-25. |
| 57. | López E, de la Torre-Luque A, Lazo A, et al. Assessment of sleep disturbances in patients with cancer: Cross-sectional study in a radiotherapy department. Eur J Oncol Nurs 2016;20:71-6. |
| 58. | Holliday EB, Dieckmann NF, McDonald TL, et al. Relationship between fatigue, sleep quality and inflammatory cytokines during external beam radiation therapy for prostate cancer: A prospective study. Radiother Oncol 2016;118:105-11. |
| 59. | Kwekkeboom KL, Tostrud L, Costanzo E, et al. The role of inflammation in the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer. J Pain Symptom Manage 2018;55:1286-95. |
| 60. | Steel JL, Terhorst L, Collins KP, et al. Prospective analyses of cytokine mediation of sleep and survival in the context of advanced cancer. Psychosom Med 2018;80:483-91. |
| 61. | Palesh O, Aldridge-Gerry A, Ulusakarya A, et al. Sleep disruption in breast cancer patients and survivors. J Natl Compr Canc Netw 2013;11:1523-30. |
| 62. | |
| 63. | Conley S, Knies A, Batten J, et al. Agreement between actigraphic and polysomnographic measures of sleep in adults with and without chronic conditions: A systematic review and meta-analysis. Sleep Med Rev 2019;46:151-60. |
| 64. | Scott H, Lack L, Lovato N. A systematic review of the accuracy of sleep wearable devices for estimating sleep onset. Sleep Med Rev 2020;49:101227. |
| 65. | George CF. Standards for polysomnography in Canada. The standards committees of the Canadian Sleep Society and the Canadian Thoracic Society. CMAJ 1996;155:1673-8. |
| 66. | Acebo C, LeBourgeois MK. Actigraphy. Respir Care Clin N Am 2006;12:23-30, viii. |
| 67. | Buysse DJ, Reynolds CF 3 rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213. |
| 68. | Beck SL, Schwartz AL, Towsley G, et al. Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. J Pain Symptom Manage 2004;27:140-8. |
| 69. | Otte JL, Payne JK, Carpenter JS. Nighttime variability in wrist actigraphy. J Nurs Meas 2011;19:105-14. |
| 70. | Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991;14:540-5. |
| 71. | Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001;2:297-307. |
| 72. | Ibáñez V, Silva J, Cauli O. A survey on sleep questionnaires and diaries. Sleep Med 2018;42:90-6. |
| 73. | Garland SN, Xie SX, Li Q, et al. Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: A randomized trial. Menopause 2017;24:517-23. |
| 74. | Johnson JA, Rash JA, Campbell TS, et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev 2016;27:20-8. |
| 75. | Savard J, Ivers H, Savard MH, et al. Long-term effects of two formats of cognitive behavioral therapy for insomnia comorbid with breast cancer. Sleep 2016;39:813-23. |
| 76. | Reich RR, Lengacher CA, Alinat CB, et al. Mindfulness-based stress reduction in post-treatment breast cancer patients: Immediate and sustained effects across multiple symptom clusters. J Pain Symptom Manage 2017;53:85-95. |
| 77. | Johns SA, Brown LF, Beck-Coon K, et al. Randomized controlled pilot trial of mindfulness-based stress reduction compared to psychoeducational support for persistently fatigued breast and colorectal cancer survivors. Support Care Cancer 2016;24:4085-96. |
| 78. | Haller H, Winkler MM, Klose P, et al. Mindfulness-based interventions for women with breast cancer: An updated systematic review and meta-analysis. Acta Oncol 2017;56:1665-76. |
| 79. | Cramer H, Lauche R, Klose P, et al. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev 2017;1:CD010802. |
| 80. | Haghayegh S, Khoshnevis S, Smolensky MH, et al. Before-bedtime passive body heating by warm shower or bath to improve sleep: A systematic review and meta-analysis. Sleep Med Rev 2019;46:124-35. |
| 81. | Choi TY, Kim JI, Lim HJ, et al. Acupuncture for managing cancer-related insomnia: A systematic review of randomized clinical trials. Integr Cancer Ther 2017;16:135-46. |
| 82. | Wayne PM, Lee MS, Novakowski J, et al. Tai Chi and Qigong for cancer-related symptoms and quality of life: A systematic review and meta-analysis. J Cancer Surviv 2018;12:256-67. |
| 83. | Kashani F, Kashani P. The effect of massage therapy on the quality of sleep in breast cancer patients. Iran J Nurs Midwifery Res 2014;19:113-8. |
| 84. | Mercier J, Savard J, Bernard P. Exercise interventions to improve sleep in cancer patients: A systematic review and meta-analysis. Sleep Med Rev 2017;36:43-56. |
| 85. | Chiu HY, Huang HC, Chen PY, et al. Walking improves sleep in individuals with cancer: A meta-analysis of randomized, controlled trials. Oncol Nurs Forum 2015;42:E54-62. |
| 86. | Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017;13:307-49. |
| 87. | Matthews E, Carter P, Page M, et al. Sleep-wake disturbance: A systematic review of evidence-based interventions for management in patients with cancer. Clin J Oncol Nurs 2018;22:37-52. |
|
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