Lubas Margaret M, Szklo-Coxe Mariana, Mandrell Belinda N, Howell Carrie R, Ness Kirsten K, Srivastava Deo Kumar, Hudson Melissa M, Robison Leslie L, Krull Kevin R, Brinkman Tara M
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA.
School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA.
Support Care Cancer. 2022 Feb;30(2):1159-1168. doi: 10.1007/s00520-021-06498-x. Epub 2021 Aug 26.
To examine self-reported (30-day) sleep versus nightly actigraphy-assessed sleep concordance in long-term survivors of childhood cancer.
Four hundred seventy-seven participants enrolled in the St. Jude Lifetime Cohort (53.5% female, median (range) age 34.3 (19.3-61.6) years, 25.4 (10.9-49.3) years from diagnosis) completed the Pittsburgh Sleep Quality Index and ≥ 3 nights of actigraphy. Participants had neurocognitive impairment and/or a self-reported prolonged sleep onset latency (SOL). Self-reported 30-day sleep and nightly actigraphic sleep measures for sleep duration, SOL, and sleep efficiency (SE) were converted into ordinal categories for calculation of weighted kappa coefficients. General linear models estimated associations between measurement concordance and late effects.
Agreements between self-reported and actigraphic measures were slight to fair for sleep duration and SOL measures (k = 0.20 and k = 0.22, respectively; p < 0.0001) and poor for SE measures (k = 0.00, p = 0.79). In multivariable models, severe fatigue and poor sleep quality were significantly associated with greater absolute differences between self-reported and actigraphy-assessed sleep durations (B = 26.6 [p < 0.001] and B = 26.8 [p = 0.01], respectively). Survivors with (versus without) memory impairment had a 44-min higher absolute difference in sleep duration (B = 44.4, p < 0.001). Survivors with, versus without, depression and poor sleep quality had higher absolute discrepancies of SOL (B = 24.5 [p = 0.01] and B = 16.4 [p < 0.0001], respectively). Poor sleep quality was associated with a 12% higher absolute difference in SE (B = 12.32, p < 0.0001).
Self-reported sleep and actigraphic sleep demonstrated discordance in our sample. Several prevalent late effects were statistically significantly associated with increased measurement discrepancy. Future studies should consider the impacts of late effects on sleep assessment in adult survivors of childhood cancer.
研究儿童癌症长期幸存者自我报告的（30天）睡眠与夜间活动记录仪评估的睡眠之间的一致性。
477名参加圣裘德终身队列研究的参与者（53.5%为女性，年龄中位数（范围）为34.3（19.3 - 61.6）岁，自诊断起25.4（10.9 - 49.3）年）完成了匹兹堡睡眠质量指数和≥3晚的活动记录仪监测。参与者存在神经认知障碍和/或自我报告的入睡潜伏期（SOL）延长。将自我报告的30天睡眠和夜间活动记录仪记录的睡眠时间、SOL及睡眠效率（SE）测量值转换为有序类别，以计算加权kappa系数。采用一般线性模型估计测量一致性与远期效应之间的关联。
自我报告与活动记录仪测量在睡眠时间和SOL测量方面的一致性为轻微到中等（kappa分别为0.20和0.22；p < 0.0001），而在SE测量方面一致性较差（kappa = 0.00，p = 0.79）。在多变量模型中，严重疲劳和睡眠质量差与自我报告和活动记录仪评估的睡眠时间之间的绝对差异更大显著相关（B分别为26.6 [p < 0.001]和26.8 [p = 0.01]）。有（对比无）记忆障碍的幸存者睡眠时间的绝对差异高44分钟（B = 44.4，p < 0.001）。有（对比无）抑郁和睡眠质量差的幸存者SOL的绝对差异更高（B分别为24.5 [p = 0.01]和16.4 [p < 0.0001]）。睡眠质量差与SE的绝对差异高12%相关（B = 12.32，p < 0.0001）。
在我们的样本中，自我报告的睡眠和活动记录仪记录的睡眠存在不一致。几种常见的远期效应与测量差异增加在统计学上显著相关。未来的研究应考虑远期效应对儿童癌症成年幸存者睡眠评估的影响。
