Associating sleep problems with advanced cancer diagnosis, and immune checkpoint treatment outcomes: a pilot study

Abstract

Background Sleep problems (SP) are common in cancer patients but have not been previously assessed in patients receiving immune checkpoint inhibitors (ICI). Methods We collected questionnaire data on sleep apnea risk, insomnia, and general sleep patterns. We used an adjusted multivariate Poisson regression to calculate prevalence ratios (PRs) and associated 95% confidence intervals (CIs) for associations between these SP and metastatic versus localized cancer stage (M1 vs. M0), and adjusted logistic regression models to calculate ORs for associations between SP with the number of ICI infusions completed (6 + vs. < 6). Results Among 32 patients who received ICI treatment, the prevalence of low, intermediate, and high-risk OSA risk was 36%, 42%, and 21%, respectively. Overall, 58% of participants reported clinically significant insomnia. We did not find a significant association between intermediate or high risk OSA (vs. low risk) and metastatic cancer status ( PR = 1.01 (95% CI : 0.28, 3.67)). Patients in the cohort who reported taking > 15 min to fall asleep were 3.6 times more likely to be diagnosed with metastatic cancer compared to those reporting shorter sleep latency (95% CI (1.74, 7.35)). We did not find a significant association between SP and number of ICI infusions completed. Conclusion Our data associating sleep apnea risk, insomnia, and sleep patterns with more advanced cancer encourages further exploration in larger-scale observational studies and suggests interventional clinical trials focused on sleep quality improvement that could result in better outcomes for these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-06825-w.

Insomnia in patients treated with checkpoint inhibitors for cancer: A meta-analysis

“…Insomnia as an adverse event represents an increase in the severity of the symptom over the study period and the follow-up. Thus, the relatively low incidence of insomnia in the analysed studies does not reflect the pre-existing insomnia which is thought to affect 30-75% of cancer patients, a prevalence approximately three times higher than in the healthy population ( 1 , 10 , 93 , 94 ). In a very recent study, Ashraf et al.…”

“…A recent pioneering study, the first to look specifically at the population of cancer patients treated with CPI has been published by ( 10 ). They did not find any association between the occurrence of insomnia, obstructive sleep apnoea and the number of CPI infusions.…”

“…On the other hand, the chronic inflammatory state associated with conditions such as diabetes, autoimmune disease, and cancer has been shown to trigger disruption in circadian rhythm manifesting as insomnia ( 5 – 7 ). Systemic cancer treatments including chemotherapy, hormonal therapy, and immunotherapy using checkpoint inhibitors (CPI) have been associated with insomnia ( 8 – 10 ). CPIs are a part of standard treatment for many solid and haematological malignancies, radically improving the prognosis of a significant proportion of patients.…”