Strøm Louise, Danielsen Josefine T, Amidi Ali, Cardenas Egusquiza Ana Lucia, Wu Lisa Maria, Zachariae Robert
Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
Department of Psychology and Behavioral Sciences, Center for Autobiographical Memory Research, Aarhus University, Aarhus, Denmark.
Front Neurosci. 2022 Apr 19;16:817837. doi: 10.3389/fnins.2022.817837. eCollection 2022.
Disrupted sleep and sleep-wake activity are frequently observed in cancer patients undergoing oncological treatment. These disruptions are often associated with aggravated symptom burden and diminished health-related quality of life that in turn may compromise treatment adherence and, thus, effectiveness. In addition, disrupted sleep has been linked to carcinogenic processes, which ultimately could result in worse prognostic outcomes.
Our aim was to systematically review and conduct a meta-analysis of studies examining the associations between sleep and sleep-wake activity and prognostic outcomes in cancer patients undergoing oncological treatment.
A comprehensive systematic search of English language papers was undertaken in June 2020 using PubMed, The Cochrane Library, and CINAHL. Two reviewers independently screened 4,879 abstracts. A total of 26 papers were included in the narrative review. Thirteen papers reporting hazard ratios reflecting associations between a dichotomized predictor variable (sleep) and prognostic outcomes were subjected to meta-analysis.
Nineteen of the 26 eligible studies on a total of 7,092 cancer patients reported associations between poorer sleep and poorer response to treatment, shorter time to progression, and/or reduced overall survival, but were highly heterogeneous with respect to the sleep and outcome parameters investigated. Meta-analysis revealed statistically significant associations between poor self-reported sleep and reduced overall survival (HR = 1.33 [95% CI 1.09-1.62], = 11), and shorter time to progression (HR = 1.40 [95% CI 1.23-1.59], = 3) and between poor objectively assessed sleep and reduced overall survival (HR = 1.74 [95% CI 1.05-2.88], = 4).
The current findings indicate that disturbed sleep during treatment may be a relevant behavioral marker of poor cancer prognosis. The limited number of studies, the common use of single item sleep measures, and potential publication bias highlight the need for further high quality and longitudinal studies.
在接受肿瘤治疗的癌症患者中，睡眠中断和睡眠-觉醒活动紊乱现象屡见不鲜。这些紊乱往往与症状负担加重和健康相关生活质量下降有关，进而可能影响治疗依从性，最终影响治疗效果。此外，睡眠中断与致癌过程有关，这最终可能导致更差的预后结果。
我们的目的是系统回顾并对研究睡眠及睡眠-觉醒活动与接受肿瘤治疗的癌症患者预后结果之间关联的研究进行荟萃分析。
2020年6月，我们使用PubMed、Cochrane图书馆和CINAHL对英文论文进行了全面的系统检索。两名评审员独立筛选了4879篇摘要。共有26篇论文纳入叙述性综述。13篇报告了反映二分预测变量（睡眠）与预后结果之间关联的风险比的论文进行了荟萃分析。
在总共7092名癌症患者的26项符合条件的研究中，有19项报告了较差的睡眠与较差的治疗反应、较短的疾病进展时间和/或较低的总生存率之间的关联，但在所研究的睡眠和结果参数方面存在高度异质性。荟萃分析显示，自我报告的睡眠质量差与总生存率降低（HR = 1.33 [95% CI 1.09 - 1.62]，I² = 11）以及较短的疾病进展时间（HR = 1.40 [95% CI 1.23 - 1.59]，I² = 3）之间存在统计学上的显著关联，客观评估的睡眠质量差与总生存率降低之间也存在关联（HR = 1.74 [95% CI 1.05 - 2.88]，I² = 4）。
目前的研究结果表明，治疗期间睡眠紊乱可能是癌症预后不良的一个相关行为指标。研究数量有限、常用单项睡眠测量方法以及潜在的发表偏倚凸显了进一步开展高质量纵向研究的必要性。
