Sleep quality following hematopoietic stem cell transplantation: longitudinal trajectories and biobehavioral correlates

Abstract

The present study examined changes in sleep quality following hematopoietic stem cell transplantation (HSCT) and investigated associations with biobehavioral factors. Individuals undergoing HSCT for hematologic malignancies (N = 228) completed measures of sleep quality and psychological symptoms pre-transplant and 1, 3, 6 and 12 months post transplant. Circulating inflammatory cytokines (IL-6, TNF-α) were also assessed. Sleep quality was poorest at 1 month post transplant, improving and remaining relatively stable after 3 months post transplant. However, approximately half of participants continued to experience significant sleep disturbance at 6 and 12 months post transplant. Mixed-effects linear regression models indicated that depression and anxiety were associated with poorer sleep quality, while psychological well-being was associated with better sleep. Higher circulating levels of IL-6 were also linked with poorer sleep. Subject-level fixed effects models demonstrated that among individual participants, changes in depression, anxiety and psychological well-being were associated with corresponding changes in sleep after covarying for the effects of time since transplant. Sleep disturbance was most severe when depression and anxiety were greatest and psychological well-being was lowest. Findings indicate that sleep disturbance is a persistent problem during the year following HSCT. Patients experiencing depression or anxiety and those with elevated inflammation may be at particular risk for poor sleep.

Everyday life following hematopoietic stem cell transplantation: decline in physical symptoms within the first month and change-related predictors

“…Moreover, a higher initial level of physical symptoms was also related to higher pre-HSCT depressive symptoms. Positive relationships between these variables were observed in previous studies [ 13 , 27 , 28 ]. One explanation for this effect is that depression is associated with increased adverse symptom burden [ 40 ] via pathophysiologic processes (e.g., increased cytokine level or other inflammatory factors) [ 41 ].…”

“…Adverse physical symptoms are common indicators of the health-related quality of life (HRQOL) physical domain [ 12 ]. Earlier studies suggest that poorer physical condition is associated with diminished well-being of patients [ 13 ], a lower psychological domain of HRQOL [ 14 ], higher distress, anxiety and depression [ 13 , 15 – 18 ], and poorer health prognosis and survival rates [ 19 – 21 ]. Physical functioning of patients after HSCT is frequently the focus of studies.…”

Prevalence and determinants of fatigue in patients with moderate to severe chronic GvHD

“…53 Other investigators have also identified reciprocal relationships among mood disturbance, sleep and fatigue in allogeneic HCT survivors. 54,55 Although parsing fatigue from depression is challenging, 56 the use of single item measures of anxiety, depression and sleep may have reduced our power to identify associations among these symptoms. Additional exploration of the relationships between fatigue and disturbances in sleep and mood in transplant survivors with cGvHD appears warranted.…”

A pilot randomized controlled trial to improve sleep and fatigue in children with central nervous system tumors hospitalized for high‐dose chemotherapy

“…Hospitalization for cancer treatment disrupts children's sleep pattern through changes in routines, environmental light and noise, pain, chemotherapy side effects, and awakenings for care provision . High‐dose chemotherapy (HDCT)/stem cell transplantation appear to confer particularly severe sleep problems, in the short‐term during transplant and over the longer‐term in survivors …”

“…severe sleep problems, in the short-term during transplant and over the longer-term in survivors. [10][11][12] Sleep disturbances are associated with significant long-term morbidities. Short duration and poor quality sleep are associated with suboptimal neurodevelopmental outcomes in healthy children, 13,14 and with development of cardiovascular and metabolic disease and obesity.…”