晚期癌症患者的睡眠障碍报告：埃德蒙顿症状评估系统睡眠项目的频率、预测因素和筛查性能。
Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item.
机构信息
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA.
Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
BMJ Support Palliat Care. 2017 Sep;7(3):274-280. doi: 10.1136/bmjspcare-2015-000847. Epub 2015 Oct 16.
AIMS
Sleep Disturbance (SD) is a severe debilitating symptom in advanced cancer patients (ACP). However, routine screening of SD is uncommon. The primary aim of this study was to determine the optimal cutoff score for SD screening for Edmonton Symptom Assessment system (ESAS) sleep item using Pittsburgh Sleep Quality Index (PSQI) as a gold standard. We also determined the frequency of SD, obstructive sleep apnea symptoms (OSA) and restless leg syndrome (RLS) and factors associated with SD.
METHODS
We prospectively surveyed 180 consecutive ACP. Patients completed validated assessment for symptoms. We determined epidemiological performance, receiver operating characteristics, and correlations of SD.
RESULTS
SD according to PSQI was diagnosed in 112/180 (62%), and median (IQR) ESAS sleep was 5 (2-7). ESAS sleep ≥ 4 had a sensitivity of 74% and 80%, and specificity of 71% and 64% in the training and validation samples, respectively for screening of SD. The frequency of OSA was 61%; RLS was 38%. ESAS sleep was associated [r, p-value] with PSQI (0.61, <0.0001), pain (0.4, <0.0001); fatigue (0.35, <0.0001); depression (0.20, 0.006); anxiety (0.385, <0.0001); drowsiness (0.385, <0.0001), shortness of breath (0.24, <0.0014); anorexia (0.32, <0.0001), well-being (0.36, <0.0001). Multivariate analysis found well-being (OR per point 1.34, p=0.0003), pain (OR 1.21, p<0.0037), dyspnea (OR 1.16, p=0.027), and OSA (OR 0.31, P=0.003) as independent predictors of SD. There was no association between SD and survival.
CONCLUSIONS
SD is frequent and ESAS SD item ≥ 4 has good sensitivity for SD screening.
目的
睡眠障碍（SD）是晚期癌症患者（ACP）严重的致残症状。然而，常规筛查 SD 并不常见。本研究的主要目的是确定使用匹兹堡睡眠质量指数（PSQI）作为金标准的 Edmonton 症状评估系统（ESAS）睡眠项目筛查 SD 的最佳截断评分。我们还确定了 SD、阻塞性睡眠呼吸暂停症状（OSA）和不宁腿综合征（RLS）的频率以及与 SD 相关的因素。
方法
我们前瞻性调查了 180 例连续 ACP。患者完成了症状的验证评估。我们确定了 SD 的流行病学表现、受试者工作特征曲线和相关性。
结果
根据 PSQI 诊断 180 例中的 112 例（62%）患有 SD，ESAS 睡眠中位数（IQR）为 5（2-7）。ESAS 睡眠≥4 时，训练和验证样本中 SD 筛查的敏感性分别为 74%和 80%，特异性分别为 71%和 64%。OSA 的频率为 61%；RLS 为 38%。ESAS 睡眠与 PSQI（r，p 值）相关[0.61，<0.0001]、疼痛（0.4，<0.0001）；疲劳（0.35，<0.0001）；抑郁（0.20，0.006）；焦虑（0.385，<0.0001）；困倦（0.385，<0.0001）；呼吸急促（0.24，<0.0014）；厌食（0.32，<0.0001）；幸福感（0.36，<0.0001）。多变量分析发现幸福感（每点 1.34 分，p=0.0003）、疼痛（OR 1.21，p<0.0037）、呼吸困难（OR 1.16，p=0.027）和 OSA（OR 0.31，P=0.003）是 SD 的独立预测因素。SD 与生存无相关性。
结论
SD 很常见，ESAS SD 项目≥4 对 SD 筛查具有良好的敏感性。
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