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. 2019 Apr;28(4):903-912.
doi: 10.1002/pon.5040. Epub 2019 Mar 14.

Sleep, emotional distress, and physical health in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Lauren C Daniel  1 , Mingjuan Wang  2 , Daniel A Mulrooney  3 , Deo Kumar Srivastava  2 , Lisa A Schwartz  4   5 , Kim Edelstein  6 , Tara M Brinkman  2   3 , Eric S Zhou  7   8 , Rebecca M Howell  9 , Todd M Gibson  3 , Wendy Leisenring  10 , Kevin C Oeffinger  11 , Joseph Neglia  12 , Leslie L Robison  3 , Gregory T Armstrong  3 , Kevin R Krull  2   3
Affiliations

Sleep, emotional distress, and physical health in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Lauren C Daniel et al. Psychooncology. 2019 Apr.

Abstract

Objective: Sleep disorders are associated with psychological and physical health, although reports in long-term survivors of childhood cancer are limited. We characterized the prevalence and risk factors for behaviors consistent with sleep disorders in survivors and examined longitudinal associations with emotional distress and physical health outcomes.

Methods: Survivors (n = 1933; median [IQR] age = 35 [30, 41]) and siblings (n = 380; age = 33 [27, 40]) from the Childhood Cancer Survivor Study completed measures of sleep quality, fatigue, and sleepiness. Emotional distress and physical health outcomes were assessed approximately 5 years before and after the sleep survey. Multivariable logistic or modified Poisson regression models examined associations with cancer diagnosis, treatment exposures, and emotional and physical health outcomes.

Results: Survivors were more likely to report poor sleep efficiency (30.8% vs 24.7%; prevalence ratio [PR] = 1.26; 95% confidence interval, 1.04-1.53), daytime sleepiness (18.7% vs 14.2%; PR = 1.31 [1.01-1.71]), and sleep supplement use (13.5% vs 8.3%; PR = 1.56 [1.09-2.22]) than siblings. Survivors who developed emotional distress were more likely to report poor sleep efficiency (PR = 1.70 [1.40-2.07]), restricted sleep time (PR = 1.35 [1.12-1.62]), fatigue (PR = 2.11 [1.92-2.32]), daytime sleepiness (PR = 2.19 [1.71-2.82]), snoring (PR = 1.85 [1.08-3.16]), and more sleep medication (PR = 2.86 [2.00-4.09]) and supplement use (PR = 1.89[1.33-2.69]). Survivors reporting symptoms of insomnia (PR = 1.46 [1.02-2.08]), fatigue (PR = 1.31 [1.01-1.72]), and using sleep medications (PR = 2.16 [1.13-4.12]) were more likely to develop migraines/headaches.

Conclusions: Survivors report more sleep difficulties and efforts to manage sleep than siblings. These sleep behaviors are related to worsening or persistently elevated emotional distress and may result in increased risk for migraines. Behavioral interventions targeting sleep may be important for improving health outcomes.

Keywords: cancer; childhood cancer survivors; emotional distress; late effects; oncology; sleep.

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Conflict of interest statement

Conflict of Interest

The authors have no conflicts of interest to declare.

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