Follow-up assessment of sleep-related symptoms in patients after treatment for cancer: responses to continuous positive airway pressure treatment for co-morbid obstructive sleep apnoea

Harini Subramanian; Ritu Trivedi; Veronika Fuchsova; Elisabeth Elder; Alison Brand; Julie Howle; Graham J Mann; Anna DeFazio; Terence Amis; Kristina Kairaitis

doi:10.1007/s11325-023-02946-6

Follow-up assessment of sleep-related symptoms in patients after treatment for cancer: responses to continuous positive airway pressure treatment for co-morbid obstructive sleep apnoea

Sleep Breath. 2023 Dec 5. doi: 10.1007/s11325-023-02946-6. Online ahead of print.

Authors

Harini Subramanian¹, Ritu Trivedi¹, Veronika Fuchsova^{1

2}, Elisabeth Elder^{2

3}, Alison Brand^{2

4}, Julie Howle^{2

5

6}, Graham J Mann^{6

7

8}, Anna DeFazio^{4

7

9}, Terence Amis^{1

2

10}, Kristina Kairaitis^{11

12

13}

Affiliations

¹ Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, Australia.
² Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.
³ Breast Cancer Institute, Westmead Hospital, Westmead, Australia.
⁴ Department of Gynaecological Oncology, Westmead Hospital, Westmead, Australia.
⁵ Crown Princess Mary Cancer Centre, Westmead and Blacktown Hospitals, Blacktown, Australia.
⁶ Melanoma Institute Australia, The University of Sydney, Camperdown, Australia.
⁷ Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, Australia.
⁸ John Curtin School of Medical Research, Australian National University, Canberra, Australia.
⁹ The Daffodil Centre, The University of Sydney, Camperdown, Australia.
¹⁰ Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Australia.
¹¹ Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, Australia. kristina.kairatis@sydney.edu.au.
¹² Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia. kristina.kairatis@sydney.edu.au.
¹³ Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Australia. kristina.kairatis@sydney.edu.au.

PMID: 38051468
DOI: 10.1007/s11325-023-02946-6

Abstract

Purpose: To assess changes in sleep-related symptoms in patients with breast cancer, endometrial cancer and melanoma previously examined for sleep-related symptoms and the presence of PSG (polysomnography)-determined OSA, ≥ 3 years post-treatment; and to evaluate how CPAP treatment affects sleep-related symptoms in patients previously diagnosed with OSA.

Methods: Patients initially recruited from breast cancer, endometrial cancer, and melanoma follow-up clinics at Westmead Hospital (Sydney, Australia) participated in this questionnaire-based study. Demographic and change in cancer status data were collected at follow-up. Patients completed the Pittsburgh Sleep Quality Index [poor sleep quality, PSQI_TOTAL ≥ 5au], Insomnia Severity Index, Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire; with ΔPSQI_TOTAL ≥ 3au indicating a clinically meaningful change in sleep quality over follow-up. PSG-determined OSA was confirmed using the apnoea-hypopnoea index. CPAP compliance was determined via self-report (CPAP compliant, CPAP; not compliant, non-CPAP). Logistic regression models determined if changes in cancer status, AHI, cancer subgroup or CPAP treatment was predictive of ΔPSQI_TOTAL ≥ 3 au and p < 0.05 indicated statistical significance.

Results: The 60 patients recruited had breast cancer (n = 22), endometrial cancer (n = 15), and melanoma (n = 23). Cancer subgroups were similarly aged, and all had median follow-up PSQI_TOTAL scores ≥ 5au; breast cancer patients scoring the highest (p < 0.05). The CPAP group had significantly reduced PSQI_TOTAL scores (p = 0.02) at follow-up, unlike the non-CPAP group. Cancer subgroups had similar median ISI_TOTAL, ESS_TOTAL and FOSQ-10_TOTAL scores at follow-up, regardless of CPAP treatment. There were no significant predictors of ΔPSQI_TOTAL ≥ 3 au at follow-up.

Conclusion: Sleep-related symptoms persist in patients with cancer ≥ 3 years after treatment, although these symptoms improve with CPAP. Future studies should evaluate how CPAP affects survival outcomes in cancer patients with comorbid OSA.

Keywords: Breast cancer; CPAP; Endometrial cancer; Longitudinal; Melanoma; Sleep symptoms.

Grants and funding

15/TRC/1-01/Sydney West Translational Cancer Research Centre