Sleep, emotional distress, and physical health in survivors of childhood cancer

A report from the Childhood Cancer Survivor Study

Lauren C. Daniel, Mingjuan Wang, Daniel A. Mulrooney, Deo Kumar Srivastava, Lisa A. Schwartz, Kim Edelstein, Tara M. Brinkman, Eric S. Zhou, Rebecca M. Howell, Todd M. Gibson, Wendy Leisenring, Kevin C. Oeffinger, Joseph Neglia, Leslie L. Robison, Gregory Armstrong, Kevin R. Krull

Research output: Contribution to journalArticle

Abstract

Objective: Sleep disorders are associated with psychological and physical health, although reports in long-term survivors of childhood cancer are limited. We characterized the prevalence and risk factors for behaviors consistent with sleep disorders in survivors and examined longitudinal associations with emotional distress and physical health outcomes. Methods: Survivors (n = 1933; median [IQR] age = 35 [30, 41]) and siblings (n = 380; age = 33 [27, 40]) from the Childhood Cancer Survivor Study completed measures of sleep quality, fatigue, and sleepiness. Emotional distress and physical health outcomes were assessed approximately 5 years before and after the sleep survey. Multivariable logistic or modified Poisson regression models examined associations with cancer diagnosis, treatment exposures, and emotional and physical health outcomes. Results: Survivors were more likely to report poor sleep efficiency (30.8% vs 24.7%; prevalence ratio [PR] = 1.26; 95% confidence interval, 1.04-1.53), daytime sleepiness (18.7% vs 14.2%; PR = 1.31 [1.01-1.71]), and sleep supplement use (13.5% vs 8.3%; PR = 1.56 [1.09-2.22]) than siblings. Survivors who developed emotional distress were more likely to report poor sleep efficiency (PR = 1.70 [1.40-2.07]), restricted sleep time (PR = 1.35 [1.12-1.62]), fatigue (PR = 2.11 [1.92-2.32]), daytime sleepiness (PR = 2.19 [1.71-2.82]), snoring (PR = 1.85 [1.08-3.16]), and more sleep medication (PR = 2.86 [2.00-4.09]) and supplement use (PR = 1.89[1.33-2.69]). Survivors reporting symptoms of insomnia (PR = 1.46 [1.02-2.08]), fatigue (PR = 1.31 [1.01-1.72]), and using sleep medications (PR = 2.16 [1.13-4.12]) were more likely to develop migraines/headaches. Conclusions: Survivors report more sleep difficulties and efforts to manage sleep than siblings. These sleep behaviors are related to worsening or persistently elevated emotional distress and may result in increased risk for migraines. Behavioral interventions targeting sleep may be important for improving health outcomes.

Original languageEnglish (US)
Pages (from-to)903-912
Number of pages10
JournalPsycho-Oncology
Volume28
Issue number4
DOIs
StatePublished - Apr 1 2019

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Survivors
Sleep
Health
Neoplasms
Fatigue
Siblings
Migraine Disorders
Snoring
Sleep Initiation and Maintenance Disorders
Risk-Taking
Confidence Intervals
Psychology

All Science Journal Classification (ASJC) codes

  • Experimental and Cognitive Psychology
  • Oncology
  • Psychiatry and Mental health

Cite this

Daniel, L. C., Wang, M., Mulrooney, D. A., Srivastava, D. K., Schwartz, L. A., Edelstein, K., ... Krull, K. R. (2019). Sleep, emotional distress, and physical health in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Psycho-Oncology, 28(4), 903-912. https://doi.org/10.1002/pon.5040

Sleep, emotional distress, and physical health in survivors of childhood cancer : A report from the Childhood Cancer Survivor Study. / Daniel, Lauren C.; Wang, Mingjuan; Mulrooney, Daniel A.; Srivastava, Deo Kumar; Schwartz, Lisa A.; Edelstein, Kim; Brinkman, Tara M.; Zhou, Eric S.; Howell, Rebecca M.; Gibson, Todd M.; Leisenring, Wendy; Oeffinger, Kevin C.; Neglia, Joseph; Robison, Leslie L.; Armstrong, Gregory; Krull, Kevin R.

In: Psycho-Oncology, Vol. 28, No. 4, 01.04.2019, p. 903-912.

Research output: Contribution to journalArticle

Daniel, LC, Wang, M, Mulrooney, DA, Srivastava, DK, Schwartz, LA, Edelstein, K, Brinkman, TM, Zhou, ES, Howell, RM, Gibson, TM, Leisenring, W, Oeffinger, KC, Neglia, J, Robison, LL, Armstrong, G & Krull, KR 2019, 'Sleep, emotional distress, and physical health in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study', Psycho-Oncology, vol. 28, no. 4, pp. 903-912. https://doi.org/10.1002/pon.5040
Daniel, Lauren C. ; Wang, Mingjuan ; Mulrooney, Daniel A. ; Srivastava, Deo Kumar ; Schwartz, Lisa A. ; Edelstein, Kim ; Brinkman, Tara M. ; Zhou, Eric S. ; Howell, Rebecca M. ; Gibson, Todd M. ; Leisenring, Wendy ; Oeffinger, Kevin C. ; Neglia, Joseph ; Robison, Leslie L. ; Armstrong, Gregory ; Krull, Kevin R. / Sleep, emotional distress, and physical health in survivors of childhood cancer : A report from the Childhood Cancer Survivor Study. In: Psycho-Oncology. 2019 ; Vol. 28, No. 4. pp. 903-912.
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title = "Sleep, emotional distress, and physical health in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study",
abstract = "Objective: Sleep disorders are associated with psychological and physical health, although reports in long-term survivors of childhood cancer are limited. We characterized the prevalence and risk factors for behaviors consistent with sleep disorders in survivors and examined longitudinal associations with emotional distress and physical health outcomes. Methods: Survivors (n = 1933; median [IQR] age = 35 [30, 41]) and siblings (n = 380; age = 33 [27, 40]) from the Childhood Cancer Survivor Study completed measures of sleep quality, fatigue, and sleepiness. Emotional distress and physical health outcomes were assessed approximately 5 years before and after the sleep survey. Multivariable logistic or modified Poisson regression models examined associations with cancer diagnosis, treatment exposures, and emotional and physical health outcomes. Results: Survivors were more likely to report poor sleep efficiency (30.8{\%} vs 24.7{\%}; prevalence ratio [PR] = 1.26; 95{\%} confidence interval, 1.04-1.53), daytime sleepiness (18.7{\%} vs 14.2{\%}; PR = 1.31 [1.01-1.71]), and sleep supplement use (13.5{\%} vs 8.3{\%}; PR = 1.56 [1.09-2.22]) than siblings. Survivors who developed emotional distress were more likely to report poor sleep efficiency (PR = 1.70 [1.40-2.07]), restricted sleep time (PR = 1.35 [1.12-1.62]), fatigue (PR = 2.11 [1.92-2.32]), daytime sleepiness (PR = 2.19 [1.71-2.82]), snoring (PR = 1.85 [1.08-3.16]), and more sleep medication (PR = 2.86 [2.00-4.09]) and supplement use (PR = 1.89[1.33-2.69]). Survivors reporting symptoms of insomnia (PR = 1.46 [1.02-2.08]), fatigue (PR = 1.31 [1.01-1.72]), and using sleep medications (PR = 2.16 [1.13-4.12]) were more likely to develop migraines/headaches. Conclusions: Survivors report more sleep difficulties and efforts to manage sleep than siblings. These sleep behaviors are related to worsening or persistently elevated emotional distress and may result in increased risk for migraines. Behavioral interventions targeting sleep may be important for improving health outcomes.",
author = "Daniel, {Lauren C.} and Mingjuan Wang and Mulrooney, {Daniel A.} and Srivastava, {Deo Kumar} and Schwartz, {Lisa A.} and Kim Edelstein and Brinkman, {Tara M.} and Zhou, {Eric S.} and Howell, {Rebecca M.} and Gibson, {Todd M.} and Wendy Leisenring and Oeffinger, {Kevin C.} and Joseph Neglia and Robison, {Leslie L.} and Gregory Armstrong and Krull, {Kevin R.}",
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T1 - Sleep, emotional distress, and physical health in survivors of childhood cancer

T2 - A report from the Childhood Cancer Survivor Study

AU - Daniel, Lauren C.

AU - Wang, Mingjuan

AU - Mulrooney, Daniel A.

AU - Srivastava, Deo Kumar

AU - Schwartz, Lisa A.

AU - Edelstein, Kim

AU - Brinkman, Tara M.

AU - Zhou, Eric S.

AU - Howell, Rebecca M.

AU - Gibson, Todd M.

AU - Leisenring, Wendy

AU - Oeffinger, Kevin C.

AU - Neglia, Joseph

AU - Robison, Leslie L.

AU - Armstrong, Gregory

AU - Krull, Kevin R.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Objective: Sleep disorders are associated with psychological and physical health, although reports in long-term survivors of childhood cancer are limited. We characterized the prevalence and risk factors for behaviors consistent with sleep disorders in survivors and examined longitudinal associations with emotional distress and physical health outcomes. Methods: Survivors (n = 1933; median [IQR] age = 35 [30, 41]) and siblings (n = 380; age = 33 [27, 40]) from the Childhood Cancer Survivor Study completed measures of sleep quality, fatigue, and sleepiness. Emotional distress and physical health outcomes were assessed approximately 5 years before and after the sleep survey. Multivariable logistic or modified Poisson regression models examined associations with cancer diagnosis, treatment exposures, and emotional and physical health outcomes. Results: Survivors were more likely to report poor sleep efficiency (30.8% vs 24.7%; prevalence ratio [PR] = 1.26; 95% confidence interval, 1.04-1.53), daytime sleepiness (18.7% vs 14.2%; PR = 1.31 [1.01-1.71]), and sleep supplement use (13.5% vs 8.3%; PR = 1.56 [1.09-2.22]) than siblings. Survivors who developed emotional distress were more likely to report poor sleep efficiency (PR = 1.70 [1.40-2.07]), restricted sleep time (PR = 1.35 [1.12-1.62]), fatigue (PR = 2.11 [1.92-2.32]), daytime sleepiness (PR = 2.19 [1.71-2.82]), snoring (PR = 1.85 [1.08-3.16]), and more sleep medication (PR = 2.86 [2.00-4.09]) and supplement use (PR = 1.89[1.33-2.69]). Survivors reporting symptoms of insomnia (PR = 1.46 [1.02-2.08]), fatigue (PR = 1.31 [1.01-1.72]), and using sleep medications (PR = 2.16 [1.13-4.12]) were more likely to develop migraines/headaches. Conclusions: Survivors report more sleep difficulties and efforts to manage sleep than siblings. These sleep behaviors are related to worsening or persistently elevated emotional distress and may result in increased risk for migraines. Behavioral interventions targeting sleep may be important for improving health outcomes.

AB - Objective: Sleep disorders are associated with psychological and physical health, although reports in long-term survivors of childhood cancer are limited. We characterized the prevalence and risk factors for behaviors consistent with sleep disorders in survivors and examined longitudinal associations with emotional distress and physical health outcomes. Methods: Survivors (n = 1933; median [IQR] age = 35 [30, 41]) and siblings (n = 380; age = 33 [27, 40]) from the Childhood Cancer Survivor Study completed measures of sleep quality, fatigue, and sleepiness. Emotional distress and physical health outcomes were assessed approximately 5 years before and after the sleep survey. Multivariable logistic or modified Poisson regression models examined associations with cancer diagnosis, treatment exposures, and emotional and physical health outcomes. Results: Survivors were more likely to report poor sleep efficiency (30.8% vs 24.7%; prevalence ratio [PR] = 1.26; 95% confidence interval, 1.04-1.53), daytime sleepiness (18.7% vs 14.2%; PR = 1.31 [1.01-1.71]), and sleep supplement use (13.5% vs 8.3%; PR = 1.56 [1.09-2.22]) than siblings. Survivors who developed emotional distress were more likely to report poor sleep efficiency (PR = 1.70 [1.40-2.07]), restricted sleep time (PR = 1.35 [1.12-1.62]), fatigue (PR = 2.11 [1.92-2.32]), daytime sleepiness (PR = 2.19 [1.71-2.82]), snoring (PR = 1.85 [1.08-3.16]), and more sleep medication (PR = 2.86 [2.00-4.09]) and supplement use (PR = 1.89[1.33-2.69]). Survivors reporting symptoms of insomnia (PR = 1.46 [1.02-2.08]), fatigue (PR = 1.31 [1.01-1.72]), and using sleep medications (PR = 2.16 [1.13-4.12]) were more likely to develop migraines/headaches. Conclusions: Survivors report more sleep difficulties and efforts to manage sleep than siblings. These sleep behaviors are related to worsening or persistently elevated emotional distress and may result in increased risk for migraines. Behavioral interventions targeting sleep may be important for improving health outcomes.

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