Søvnkvalitet hos innlagte pasienter med alvorlig kreft

Selv om pasienter med alvorlig kreftdiagnose rapporterer dårlig søvnkvalitet, er det få studier som har vurdert søvnkvalitet med en kombinasjon av subjektive og objektive målinger. Forskere fra NTNU, St. Olavs Hospital, Universitetet i Oslo, University of Aberdeen og Oslo universitetssykehus ønsket med denne studien å undersøke søvnkvaliteten hos innlagte pasienter med alvorlig kreft ved å kombinere søvndagbok og polysomnografi (PSG) eller aktigrafi. Selv om resultatene fra søvndagbok og aktigrafi viste noe ulikt, viser studien at denne pasientgruppen har dårlig søvnkvalitet. PSG var ikke gjennomførbart, og resultatene viste at man bør forbedre hvordan man vurderer søvnkvalitet og behandling av søvnforstyrrelser hos innlagte pasienter med alvorlig langtkommet kreft.

Sleep quality in hospitalized patients with advanced cancer: an observational study using self-reports of sleep and actigraphy.

Gunnhild Jakobsen, Morten Engstrøm, Morten Thronæs, Erik Torbjørn Løhre, Stein Kaasa, Peter Fayers, Marianne Jensen Hjermstad, Pål Klepstad

Studien er publisert i Supportive Care in Cancer

PURPOSE: Although patients with advanced cancer report poor sleep quality, few studies have assessed sleep quality with a combination of subjective and objective measures. We aimed to examine sleep quality in hospitalized patients with advanced cancer by combining patient-reported outcome-measures (PROMs) and polysomnography (PSG) or actigraphy.
METHODS: A one-night prospective observational study of sleep in hospitalized patients with metastatic cancer using WHO step III opioids was conducted. Total sleep time, sleep onset latency, number of awakenings, and wake after sleep onset were assessed by PROMs and actigraphy. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) (range; 0-21), where higher scores indicate worse sleep quality.
RESULTS: Forty patients were monitored. Median age was 70, median oral morphine equivalent dose was 80 mg/24 h (10-1725), median Karnofsky Performance Score was 50 (20-90), and median time to death from inclusion was 38 days (4-319). Mean PSQI score was 6.5 (SD ± 3.4). PROMs and actigraphy of mean (SD) sleep onset latency were 46 (± 64) and 35 min (± 61), respectively, while mean time awake at night was 37 (± 35) and 40 min (± 21). PROMs and actigraphy differed on number of awakenings (mean 2 (± 1) vs. 24 (± 15), p ˂ 0.001). Bland-Altman plots showed large individual differences between PROMs and actigraphy. PSG was not feasible.
CONCLUSIONS: PROMs and actigraphy documented poor sleep quality, but a lack of agreement across methods. The study demonstrates a need to improve assessment of sleep quality and treatment of sleep disturbance in hospitalized patients with advanced cancer near end of life.