Validation of actigraphy to assess circadian organization and sleep quality in patients with advanced lung cancer

Background Many cancer patients report poor sleep quality, despite having adequate time and opportunity for sleep. Satisfying sleep is dependent on a healthy circadian time structure and the circadian patterns among cancer patients are quite abnormal. Wrist actigraphy has been validated with concurrent polysomnography as a reliable tool to objectively measure many standard sleep parameters, as well as daily activity. Actigraphic and subjective sleep data are in agreement when determining activity-sleep patterns and sleep quality/quantity, each of which are severely affected in cancer patients. We investigated the relationship between actigraphic measurement of circadian organization and self-reported subjective sleep quality among patients with advanced lung cancer. Methods This cross-sectional and case control study was conducted in 84 patients with advanced non-small cell lung cancer in a hospital setting for the patients at Midwestern Regional Medical Center (MRMC), Zion, IL, USA and home setting for the patients at WJB Dorn Veterans Affairs Medical Center (VAMC), Columbia, SC, USA. Prior to chemotherapy treatment, each patient's sleep-activity cycle was measured by actigraphy over a 4-7 day period and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Results The mean age of our patients was 62 years. 65 patients were males while 19 were females. 31 patients had failed prior treatment while 52 were newly diagnosed. Actigraphy and PSQI scores showed significantly disturbed daily sleep-activity cycles and poorer sleep quality in lung cancer patients compared to healthy controls. Nearly all actigraphic parameters strongly correlated with PSQI self-reported sleep quality of inpatients and outpatients. Conclusions The correlation of daily activity/sleep time with PSQI-documented sleep indicates that actigraphy can be used as an objective tool and/or to complement subjective assessments of sleep quality in patients with advanced lung cancer. These results suggest that improvements to circadian function may also improve sleep quality.

[1]  D. J. Mullaney,et al.  Automatic sleep/wake identification from wrist activity. , 1992, Sleep.

[2]  A. Sadeh,et al.  Activity-based sleep-wake identification: an empirical test of methodological issues. , 1994, Sleep.

[3]  M. Andrykowski,et al.  Psychometric evaluation of the Pittsburgh Sleep Quality Index. , 1998, Journal of psychosomatic research.

[4]  S. Mercadante,et al.  Sleep disorders in advanced cancer patients: prevalence and factors associated , 2004, Supportive Care in Cancer.

[5]  Francine Laden,et al.  Night-shift work and risk of colorectal cancer in the nurses' health study. , 2003, Journal of the National Cancer Institute.

[6]  Judith R Davidson,et al.  Sleep disturbance in cancer patients. , 2002, Social science & medicine.

[7]  G. Jean-Louis,et al.  Determination of sleep and wakefulness with the actigraph data analysis software (ADAS). , 1996, Sleep.

[8]  A. Barsevick,et al.  Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. , 2004, Journal of pain and symptom management.

[9]  S. Hankinson,et al.  Night shift work and the risk of endometrial cancer. , 2007, Cancer research.

[10]  Francis Lévi,et al.  Disruption of circadian coordination accelerates malignant growth in mice. , 2003, Pathologie-biologie.

[11]  E. Young,et al.  Use of actigraphy for monitoring sleep and activity levels in patients with fibromyalgia and depression. , 2002, Journal of psychosomatic research.

[12]  R C Hermida,et al.  Chronolab: an interactive software package for chronobiologic time series analysis written for the Macintosh computer. , 1992, Chronobiology international.

[13]  S. Ancoli-Israel,et al.  Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. , 2004, Journal of psychosomatic research.

[14]  M. Mormont,et al.  Contribution of the rest–activity circadian rhythm to quality of life in cancer patients , 2002, Chronobiology international.

[15]  Yoshiyuki Watanabe,et al.  Prospective cohort study of the risk of prostate cancer among rotating-shift workers: findings from the Japan collaborative cohort study. , 2006, American journal of epidemiology.

[16]  D. Kripke,et al.  Variations in circadian rhythms of activity, sleep, and light exposure related to dementia in nursing-home patients. , 1997, Sleep.

[17]  F Halberg,et al.  Methods for cosinor-rhythmometry. , 1979, Chronobiologia.

[18]  J Lellouch,et al.  Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status. , 2000, Clinical cancer research : an official journal of the American Association for Cancer Research.

[19]  Kathryn A. Lee,et al.  Methodological challenges when using actigraphy in research. , 2008, Journal of pain and symptom management.

[20]  C. Guilleminault,et al.  Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. , 2004, Sleep.

[21]  H. F. Kabat,et al.  Chronobiology 1982-1983 , 1984 .

[22]  R. Stevens,et al.  Night shift work, light at night, and risk of breast cancer. , 2001, Journal of the National Cancer Institute.

[23]  N. Tinari,et al.  Relief of symptoms after gefitinib is associated with improvement of rest/activity rhythm in advanced lung cancer. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  H. Kraemer,et al.  Diurnal cortisol rhythm as a predictor of breast cancer survival. , 2000, Journal of the National Cancer Institute.

[25]  P. Hardin,et al.  Circadian rhythms from multiple oscillators: lessons from diverse organisms , 2005, Nature Reviews Genetics.

[26]  Martin H. Teicher,et al.  Circadian locomotor activity rhythms in Alzheimer's disease. , 1991, Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology.

[27]  Daniel J Buysse,et al.  The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research , 1989, Psychiatry Research.

[28]  Max Hirshkowitz,et al.  Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002. , 2003, Sleep.

[29]  F. Halberg,et al.  87 Marker Rhythms for Cancer Chrono-chemotherapy , 1984 .