Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK.
Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France.
Sleep. 2019 Oct 9;42(10). doi: 10.1093/sleep/zsz146.
Subjective sleep assessment in cancer patients poorly correlates with actigraphy parameters that usually encompass multiple nights. We aimed to determine the objective actigraphy measures that best correlated with subjective sleep ratings on a night-by-night basis in cancer patients. Thirty-one cancer patients daily self-rated sleep disturbances using the single dedicated item of the MD Anderson Symptom Inventory (0-10 scale) with 18 other items, and continuously wore a wrist actigraph for 30 days. Objective sleep parameters were computed from the actigraphy nighttime series, and correlated with subjective sleep disturbances reported on the following day, using repeated measures correlations. Multilevel Poisson regression analysis was performed to identify the objective and subjective parameters that affected subjective sleep rating. Poor subjective sleep score was correlated with poor sleep efficiency (rrm = -0.13, p = 0.002) and large number of wake episodes (rrm = 0.12, p = 0.005) on the rated night. Multilevel analysis demonstrated that the expected sleep disturbance score was affected by the joint contribution of the wake episodes (exp(β) = 1.01, 95% confidence interval = 1.00 to 1.02, p = 0.016), fatigue (exp(β) = 1.35, 95% confidence interval = 1.15 to 1.55, p < 0.001) and drowsiness (exp(β) = 1.70, 95% confidence interval = 1.19 to 2.62, p = 0.018), self-rated the following evening, and sleep disturbance experienced one night before (exp(β) = 1.77, 95% confidence interval = 1.41 to 2.22, p < 0.001). The night-by-night approach within a multidimensional home tele-monitoring framework mainly identified the objective number of wake episodes computed from actigraphy records as the main determinant of the severity of sleep complaint in cancer patients on chemotherapy. This quantitative information remotely obtained in real time from cancer patients provides a novel framework for streamlining and evaluating interventions toward sleep improvement in cancer patients.
在癌症患者中，主观睡眠评估与通常涵盖多个夜晚的活动记录仪参数相关性较差。我们旨在确定在癌症患者中，基于每夜的基础上，与主观睡眠评分相关性最佳的客观活动记录仪测量指标。31 例癌症患者每天使用 MD 安德森症状量表（0-10 分）的单一专用项目自我评估睡眠障碍，并连续佩戴腕部活动记录仪 30 天。从活动记录仪夜间系列中计算出客观睡眠参数，并使用重复测量相关性将其与次日报告的主观睡眠障碍进行相关分析。采用多级泊松回归分析确定影响主观睡眠评分的客观和主观参数。较差的主观睡眠评分与较差的睡眠效率（rrm = -0.13，p = 0.002）和大量觉醒次数（rrm = 0.12，p = 0.005）相关。多水平分析表明，预期的睡眠障碍评分受觉醒次数（exp（β）= 1.01，95%置信区间= 1.00 至 1.02，p = 0.016）、疲劳（exp（β）= 1.35，95%置信区间= 1.15 至 1.55，p < 0.001）和困倦（exp（β）= 1.70，95%置信区间= 1.19 至 2.62，p = 0.018）的共同作用以及前一晚的自我报告的影响，并且前一晚的睡眠障碍（exp（β）= 1.77，95%置信区间= 1.41 至 2.22，p < 0.001）。在多维家庭远程监测框架内的每夜方法主要确定从活动记录仪记录中计算得出的客观觉醒次数作为化疗期间癌症患者睡眠主诉严重程度的主要决定因素。从癌症患者远程实时获得的这种定量信息为简化和评估改善癌症患者睡眠的干预措施提供了新的框架。
