Davis Mellar P, Goforth Harold W
From the *Cleveland Clinic Lerner School of Medicine, Case Western Reserve University; and †Palliative Medicine and Supportive Oncology Services, Division of Solid Tumor, Taussig Cancer Institute, and ‡Neurological Institute, Department of Psychiatry and Psychology, The Cleveland Clinic, Cleveland, OH.
Cancer J. 2014 Sep-Oct;20(5):330-44. doi: 10.1097/PPO.0000000000000071.
Sleep disorders and insomnia are more prevalent in patients with cancer than in the normal population. Sleep disorders consist of delayed sleep latency, waking episodes after sleep onset, unrefreshing sleep, reduced quality of sleep, and reduced sleep efficiency. Sleep disorders cluster with pain, fatigue, depression, anxiety, and vasomotor symptoms, depending on stage of disease, treatment, and comorbidities. Premorbid sleep problems and shift work have been associated with a higher prevalence of cancer; in fact, shift work has been labeled a carcinogen. Treatment for insomnia includes cognitive behavioral therapy with sleep hygiene, bright-light therapy, exercise, yoga, melatonin, and hypnotic medications. Unfortunately, there are few randomized trials in cancer-related sleep disorders such that most recommendations particularly for hypnotics are based on treatment for primary insomnia. In this article, insomnia is reviewed as a predisposing factor to cancer, prior to and during treatment, in cancer survivorship and in advanced cancer. Recommendations for treatment are based on low-quality evidence but are also reviewed.
睡眠障碍和失眠在癌症患者中比在正常人群中更为普遍。睡眠障碍包括入睡潜伏期延长、睡眠开始后的觉醒发作、睡眠未得到恢复、睡眠质量下降以及睡眠效率降低。根据疾病阶段、治疗方法和合并症的不同，睡眠障碍常与疼痛、疲劳、抑郁、焦虑和血管舒缩症状同时出现。病前睡眠问题和轮班工作与癌症的较高患病率相关；事实上，轮班工作已被列为致癌物。失眠的治疗方法包括认知行为疗法结合睡眠卫生、强光疗法、运动、瑜伽、褪黑素和催眠药物。不幸的是，针对癌症相关睡眠障碍的随机试验很少，以至于大多数建议，特别是关于催眠药物的建议，都是基于对原发性失眠的治疗。在本文中，将对失眠作为癌症的一个诱发因素进行综述，包括在癌症治疗前、治疗期间、癌症幸存者以及晚期癌症患者中的情况。治疗建议基于低质量证据，但也会进行综述。
