title: Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item.
abstract: OBJECTIVE
  Sleep Disturbance (SD) is a severe debilitating symptom in advanced cancer patients (ACP). However, routine screening of SD is uncommon. The primary aim of this study was to determine the optimal cutoff score for SD screening for Edmonton Symptom Assessment system (ESAS) sleep item using Pittsburgh Sleep Quality Index (PSQI) as a gold standard. We also determined the frequency of SD, obstructive sleep apnea symptoms (OSA) and restless leg syndrome (RLS) and factors associated with SD.
  
  
  METHODS
  We prospectively surveyed 180 consecutive ACP. Patients completed validated assessment for symptoms. We determined epidemiological performance, receiver operating characteristics, and correlations of SD.
  
  
  RESULTS
  SD according to PSQI was diagnosed in 112/180 (62%), and median (IQR) ESAS sleep was 5 (2-7). ESAS sleep ≥ 4 had a sensitivity of 74% and 80%, and specificity of 71% and 64% in the training and validation samples, respectively for screening of SD. The frequency of OSA was 61%; RLS was 38%. ESAS sleep was associated [r, p-value] with PSQI (0.61, <0.0001), pain (0.4, <0.0001); fatigue (0.35, <0.0001); depression (0.20, 0.006); anxiety (0.385, <0.0001); drowsiness (0.385, <0.0001), shortness of breath (0.24, <0.0014); anorexia (0.32, <0.0001), well-being (0.36, <0.0001). Multivariate analysis found well-being (OR per point 1.34, p=0.0003), pain (OR 1.21, p<0.0037), dyspnea (OR 1.16, p=0.027), and OSA (OR 0.31, P=0.003) as independent predictors of SD. There was no association between SD and survival.
  
  
  CONCLUSIONS
  SD is frequent and ESAS SD item ≥ 4 has good sensitivity for SD screening.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA.
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
authors.affiliation: Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Dave
authors.initials: D
authors.lastname: Balachandran
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Pedraza Cardozo
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA.
authors.forename: Elyssa A
authors.initials: EA
authors.lastname: Berg
authors.affiliation: The University of Texas MD Anderson Cancer Center, Biostatistics, Houston, Texas, USA.
authors.forename: Gary B
authors.initials: GB
authors.lastname: Chisholm
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA.
authors.forename: Akhila
authors.initials: A
authors.lastname: Reddy
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA.
authors.forename: Vera
authors.initials: V
authors.lastname: DeLa Cruz
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Williams
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010166:Palliative Care; D011446:Prospective Studies; D011594:Psychometrics; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D019452:Terminally Ill; D013781:Texas / Q000453:epidemiology
keywords: Cancer; Clinical assessment; Quality of life; Supportive care; Symptoms and symptom management