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Sleep-Wake Circadian Activity Rhythm Parameters and Fatigue in Oncology Patients Before the Initiation of Radiation Therapy

Miaskowski, Christine PhD, RN, FAAN; Lee, Kathryn PhD, RN, FAAN; Dunn, Laura MD; Dodd, Marylin PhD, RN, FAAN; Aouizerat, Bradley E. PhD, MAS; West, Claudia MS, RN; Paul, Steven M. PhD; Cooper, Bruce PhD; Wara, William MD; Swift, Patrick MD

doi: 10.1097/NCC.0b013e3181f65d9b

Background: Little is known about the relationships between sleep parameters and fatigue in patients at the initiation of radiation therapy (RT).

Objectives: The objectives of this study were to describe values for nocturnal sleep/rest, daytime wake/activity, and circadian activity rhythm parameters measured using actigraphy and to evaluate the relationships between these objective parameters and subjective ratings of sleep disturbance and fatigue severity, in a sample of patients at the initiation of RT.

Methods: Patients (n = 185) with breast, prostate, lung, or brain cancer completed self-report measures for sleep disturbance (ie, Pittsburgh Sleep Quality Index, General Sleep Disturbance Scale) and fatigue (Lee Fatigue Scale) and wore wrist actigraphs for a total of 48 hours prior to beginning RT. Actigraphy data were analyzed using the Cole-Kripke algorithm. Spearman rank correlations were calculated between variables.

Results: Approximately 30% to 50% of patients experienced sleep disturbance, depending on whether clinically significant cutoffs for the subjective or objective measures were used to calculate occurrence rates. In addition, these patients reported moderate levels of fatigue. Only a limited number of significant correlations were found between the subjective and objective measures of sleep disturbance. Significant positive correlations were found between the subjective, but not the objective measures of sleep disturbance and fatigue.

Conclusions: A significant percentage of oncology patients experience significant disturbances in sleep-wake circadian activity rhythms at the initiation of RT. The disturbances occur in both sleep initiation and sleep maintenance.

Implications for Practice: Patients need to be assessed at the initiation of RT for sleep disturbance, so appropriate treatment is initiated.

Author Affiliations: Departments of Physiological Nursing (Drs Miaskowski, Dodd, Aouizerat, and Paul and Ms West), Family Health Care Nursing (Dr Lee), Community Health Systems (Dr Cooper), and Psychiatry (Dr Dunn), University of California, San Francisco; Kaiser Permanente, San Francisco, California (Dr Wara); and Alta Bates Comprehensive Cancer Center, Berkeley, California (Dr Swift).

This research was supported by a grant from the National Institute of Nursing Research (NR04835). Dr Miaskowski receives support from the American Cancer Society as a clinical research professor. Dr Aouizerat is funded through the National Institutes of Health Roadmap for Medical Research grant (KL2 RR624130). Dr Dunn received funding from the Mount Zion Health Fund and the University of California, San Francisco, Academic Senate.

Correspondence: Christine Miaskowski, PhD, RN, FAAN, Department of Physiological Nursing, University of California, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610 ( Accepted for publication August 1, 2010.

© 2011 Lippincott Williams & Wilkins, Inc.