James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Support Care Cancer. 2017 Oct;25(10):3161-3169. doi: 10.1007/s00520-017-3724-6. Epub 2017 Apr 28.
Although sleep disturbances are common in older adults, studies evaluating the prevalence of sleep disturbance and its influence on functional outcomes in older adults with cancer are few. In this study, we examined the prevalence of sleep disturbance and its association with physical function and cognition in older adults with cancer.
This is a cross-sectional study of patients who were referred and evaluated in the Specialized Oncology Care & Research in the Elderly (SOCARE) clinics at the Universities of Rochester and Chicago from May 2011 to October 2015. All patients underwent a geriatric assessment (GA) as part of their routine evaluation. Our final study cohort included patients who completed a sleep assessment and consented to the study. We collected demographics (age, sex, race, marital status, and education level) and clinical characteristics (depression, comorbidity, cancer type, and stage) from the GA and medical chart reviews. Presence of sleep disturbance was self-reported (yes/no). Physical function was assessed using Instrumental Activities of Daily Living (IADLs), physical activity (PA) survey, falls in the preceding 6 months, and Short Physical Performance Battery (SPPB). Cognition was screened using the Blessed Orientation-Memory-Concentration Test (impairment >4) or Montreal Cognitive Assessment (impairment <26). Bivariate and multivariable analyses were used to examine the associations between sleep disturbance with functional outcomes and cognition.
We included 389 older patients. The prevalence of sleep disturbance was 40%. Sixty-eight percent had ≥1 IADL impairment, 76% had PA limitation, 37% had ≥1 fall, 70% had impairment on SPPB, and 47% screened positive for cognitive impairment. On bivariate analyses, sleep disturbance was associated with IADL impairment (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.23-3.13, P = 0.005), and PA limitation (OR 2.43, 95% CI 1.38-4.28, P = 0.002). The associations remained significant on multivariable analyses. Sleep disturbance was not significantly associated with falls, impairment on SPPB, and performance on the cognitive screen.
Sleep disturbance was associated with IADL impairment and PA limitation. It is important for oncologists to inquire about sleep problems, and these patients should also be screened for functional impairment if sleep disturbance was present.
尽管睡眠障碍在老年人中很常见，但评估老年人癌症患者睡眠障碍的患病率及其对功能结局的影响的研究却很少。本研究旨在调查癌症老年患者睡眠障碍的患病率及其与身体功能和认知的关系。
这是一项横断面研究，对象为 2011 年 5 月至 2015 年 10 月在罗切斯特大学和芝加哥大学的专业肿瘤老年关怀和研究 (SOCARE) 诊所就诊和评估的患者。所有患者均接受老年综合评估 (GA)，作为其常规评估的一部分。我们的最终研究队列纳入了完成睡眠评估并同意参与研究的患者。我们从 GA 和病历回顾中收集人口统计学信息 (年龄、性别、种族、婚姻状况和教育程度) 和临床特征 (抑郁、合并症、癌症类型和分期)。睡眠障碍的存在通过自我报告 (是/否) 来确定。身体功能使用工具性日常生活活动 (IADL)、体力活动 (PA) 调查、过去 6 个月内的跌倒和简短体能状况测试 (SPPB) 来评估。认知功能通过Blessed 定向-记忆-注意力测验 (障碍 >4) 或蒙特利尔认知评估 (障碍 <26) 进行筛查。使用二变量和多变量分析来检查睡眠障碍与功能结局和认知之间的关系。
我们纳入了 389 名老年患者。睡眠障碍的患病率为 40%。68%的患者有≥1 项 IADL 障碍，76%的患者有 PA 受限，37%的患者有≥1 次跌倒，70%的患者 SPPB 受损，47%的患者认知障碍筛查阳性。在单变量分析中，睡眠障碍与 IADL 障碍 (优势比 [OR] 1.96，95%置信区间 [CI] 1.23-3.13，P=0.005) 和 PA 受限 (OR 2.43，95% CI 1.38-4.28，P=0.002) 相关。多变量分析结果仍然显著。睡眠障碍与跌倒、SPPB 受损和认知筛查表现无显著相关性。
睡眠障碍与 IADL 障碍和 PA 受限有关。肿瘤学家询问睡眠问题很重要，如果存在睡眠障碍，也应对这些患者进行功能障碍筛查。
