title: Sleep duration is associated with survival in advanced cancer patients.
abstract: OBJECTIVE
  Sleep problems have been linked to increased risk of mortality in the general population. Limited evidence suggests similar relationships among people diagnosed with cancer. The aims of the present study were to investigate the type and rates of sleep problems in advanced cancer patients and examine whether sleep problems are associated with survival.
  
  
  METHODS
  A prospective study of 292 patients with advanced cancers affecting the hepatobiliary and pancreatic systems were administered a battery of questionnaires measuring sociodemographic information, sleep, and depression. Descriptive statistics, ANOVA, Chi-square, Kaplan-Meier survival, and Cox regression analyses were performed to test the aims.
  
  
  RESULTS
  The majority of patients were male (64%) and the mean age was 62 years (SD = 11). Fifty-nine percent of patients reported poor sleep quality; 43% reported sleeping ≤6 h and 2% ≥10 h; 40% reported sleep latency of 30 min or greater; average sleep efficiency was 80%. Of the 292 patients, 58% reported clinically levels of depression and depressive symptoms were related to shorter sleep duration (p = 0.02). After adjusting for factors known to contribute to survival, a curvilinear relationship was observed between sleep duration and mortality: short and long sleep duration were associated with increased mortality [linear term: hazard ratio (HR) = 0.485, 95% confidence interval (CI) = 0.275-0.857; quadratic term: HR = 1.064, 95% CI = 1.015-1.115].
  
  
  CONCLUSIONS
  Consistent with findings in the general population, a curvilinear relationship between sleep duration and mortality was observed in advanced cancer patients. The high prevalence of sleep problems and link with mortality warrants routine screening and development of evidence-based treatments for sleep problems in the oncology setting.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Collins
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.affiliation: Department of Psychology, University of Miami, Miami, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Antoni
authors.affiliation: Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Drew Michael
authors.initials: DM
authors.lastname: Donnell
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Allan
authors.initials: A
authors.lastname: Tsung
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Marsh
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Lora
authors.initials: L
authors.lastname: Burke
authors.affiliation: Department of Medical Social Sciences, Psychology, and Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Penedo
authors.affiliation: Department of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Terhorst
authors.affiliation: Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Kamarck
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Greene
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: steeljl@upmc.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Steel
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012890:Sleep; D012893:Sleep Wake Disorders / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Cancer; Hepatobiliary; PSQI; Sleep; Sleep duration; Survival