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Frequency and characteristics of drowsiness, somnolence, or daytime sleepiness in patients with advanced cancer

Published online by Cambridge University Press:  04 December 2018

Sriram Yennurajalingam ,
Srikanth Reddy Barla ,
Joseph Arthur ,
Gary B. Chisholm  and
Eduardo Bruera
Sriram Yennurajalingam*
Affiliation:
Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Srikanth Reddy Barla
Affiliation:
Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Joseph Arthur
Affiliation:
Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
Gary B. Chisholm
Affiliation:
Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
Eduardo Bruera
Affiliation:
Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
*
Author for correspondence: Sriram Yennurajalingam, MD, MS, Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd., Houston, TX 77030. E-mail: [email protected]
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Abstract

Introduction

Cancer-related drowsiness (CRD) is a distressing symptom in advanced cancer patients (ACP). The aim of this study was to determine the frequency and factors associated with severity of CRD. We also evaluated the screening performance of Edmonton Symptom Assessment Scale-drowsiness (ESAS-D) item against the Epworth Sedation Scale (ESS).

Method

We prospectively assessed 180 consecutive ACP at a tertiary cancer hospital. Patients were surveyed using ESAS, ESS, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Hospital Anxiety Depression Scale.

Result

Ninety of 150 evaluable patients had clinically significant CRD (ESS); median (interquartile ratio): ESS. 11 (7–14); ESAS-D. 5 (2–6); Pittsburgh Sleep Quality Index. 8 (5–11); Insomnia Severity Index. 13 (5–19); Stop Bang Scoring 3 (2–4), and Hospital Anxiety Depression Scale-D 6 (3–10). ESAS-D was associated with ESAS (r, p) sleep (0.38, <0.0001); pain (0.3, <0.0001); fatigue (0.51, <0.0001); depression (0.39, <0.0001); anxiety (0.44, <0.0001); shortness of breath (0.32, <0.0001); anorexia (0.36, <0.0001), feeling of well-being [(0.41, <0.0001), ESS (0.24, 0.001), and opioid daily dose (0.19, 0.01). Multivariate-analysis showed ESAS-D was associated with fatigue (odds ratio [OR] = 9.08, p < 0.0001), anxiety (3.0, p = 0.009); feeling of well-being (OR = 2.27, p = 0.04), and insomnia (OR = 2.35; p = 0.036). Insomnia (OR = 2.35; p = 0.036) cutoff score ≥3 (of 10) resulted in a sensitivity of 81% and 32% and specificity of 70% and 44% in the training and validation samples, respectively.

Significance of results

Clinically significant CRD is frequent and seen in 50% of ACP. CRD was associated with severity of insomnia, fatigue, anxiety, and worse feeling of well-being. An ESAS-D score of ≥3 is likely to identify most of the ACP with significant CRD.

Keywords

Daytime sleepinessDrowsinessPalliative careSleep wake disturbancesSomnolenceSupportive Care
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 4 , August 2019 , pp. 459 - 463
Copyright
Copyright © Cambridge University Press 2018 

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