Abstract
Background
This study aimed to determine whether: 1) sleep quality was associated with overall survival (OS) among a heterogeneous sample of cancer survivors; 2) this association differed per cancer diagnosis; 3) aspects of sleep quality (e.g., sleep latency, daytime dysfunction) were associated with OS among a subsample of colorectal cancer (CRC) survivors; and 4) adjustment for depressive symptoms changed these associations.
Methods
Several cohorts from the population-based PROFILES registry, including adult cancer survivors diagnosed between 1990 and 2014 with 11 cancer diagnoses, were used. Data on sleep quality (3 categories: no, nonclinically, and clinically important sleep quality impairment) was collected through the insomnia scale of theEORTC QLQ-C30 and the PSQI for CRC survivors only (n = 1245). Clinical data were obtained through the Netherlands Cancer Registry. Cox regression analysis was used to assess adjusted hazard ratios (HRs).
Results
7195 participants were included, of which 36 % died (median follow-up since inclusion, 9 years). Clinically impaired sleep quality was associated with lower OS (HR, 1.17[1.05; 1.30]) compared to no sleep problems. Stratification by cancer diagnosis suggested a consistent pattern. After adjusting for depressive
symptoms, sleep quality was no longer significantly associated with OS (HR, 1.10[0.97; 1.24]). Daytime dysfunction and long sleep duration were significantly associated with lower OS in CRC survivors, also after adjustment for depressive symptoms.
Conclusion
Cancer patients reporting clinically low sleep quality had a lower OS. However, this might be partly explained by patients’ depressive symptoms. In CRC survivors, daytime dysfunction and long sleep duration were, independent of depressive symptoms, related to lower OS.
This study aimed to determine whether: 1) sleep quality was associated with overall survival (OS) among a heterogeneous sample of cancer survivors; 2) this association differed per cancer diagnosis; 3) aspects of sleep quality (e.g., sleep latency, daytime dysfunction) were associated with OS among a subsample of colorectal cancer (CRC) survivors; and 4) adjustment for depressive symptoms changed these associations.
Methods
Several cohorts from the population-based PROFILES registry, including adult cancer survivors diagnosed between 1990 and 2014 with 11 cancer diagnoses, were used. Data on sleep quality (3 categories: no, nonclinically, and clinically important sleep quality impairment) was collected through the insomnia scale of theEORTC QLQ-C30 and the PSQI for CRC survivors only (n = 1245). Clinical data were obtained through the Netherlands Cancer Registry. Cox regression analysis was used to assess adjusted hazard ratios (HRs).
Results
7195 participants were included, of which 36 % died (median follow-up since inclusion, 9 years). Clinically impaired sleep quality was associated with lower OS (HR, 1.17[1.05; 1.30]) compared to no sleep problems. Stratification by cancer diagnosis suggested a consistent pattern. After adjusting for depressive
symptoms, sleep quality was no longer significantly associated with OS (HR, 1.10[0.97; 1.24]). Daytime dysfunction and long sleep duration were significantly associated with lower OS in CRC survivors, also after adjustment for depressive symptoms.
Conclusion
Cancer patients reporting clinically low sleep quality had a lower OS. However, this might be partly explained by patients’ depressive symptoms. In CRC survivors, daytime dysfunction and long sleep duration were, independent of depressive symptoms, related to lower OS.
| Original language | English |
|---|---|
| Article number | 106488 |
| Number of pages | 9 |
| Journal | Sleep Medicine |
| Volume | 131 |
| Early online date | 2 Apr 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 2 Apr 2025 |
Keywords
- Cancer
- Depression
- Overall survival
- Sleep duration
- Sleep quality