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Correlates of disrupted sleep–wake variables in patients with advanced cancer
  1. Marie Solange Bernatchez1,2,3,
  2. Josée Savard1,2,3,
  3. Michèle Aubin4 and
  4. Hans Ivers1,2,3
  1. 1 School of Psychology, Université Laval, Quebec City, Quebec, Canada
  2. 2 CHU de Québec–Université Laval Research Center, Quebec City, Quebec, Canada
  3. 3 Université Laval Cancer Research Center, Quebec City, Quebec, Canada
  4. 4 Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Quebec, Canada
  1. Correspondence to Dr Josée Savard, Centre de recherche du CHU de Québec-Université Laval, Québec G1R 2J6, Canada; josee.savard{at}


Objectives High rates of sleep difficulties have been found in patients with advanced cancer. However, not much is known about factors that are associated with sleep impairments in this population and that could constitute their potential risk factors or consequences. This study conducted in patients with cancer receiving palliative care aimed to evaluate the relationships of subjective (sleep diary; Insomnia Severity Index, ISI) and objective (actigraphy) sleep–wake variables with several physical and psychological symptoms, maladaptive sleep behaviours, erroneous beliefs about sleep, quality of life, time to death and environmental factors.

Methods The sample was composed of 57 community-dwelling patients with cancer receiving palliative care and with an Eastern Cooperative Oncology Group Scale score of 2 or 3. Actigraphic, light and sound recording and a daily sleep and pain diary were completed for seven consecutive days. A battery of self-report scales was also administered.

Results Greater disruptions of subjective and objective sleep–wake variables were more consistently associated with worse physical symptoms than with psychological variables. Disrupted objective sleep–wake parameters were also associated with a greater frequency of maladaptive sleep behaviours. Finally, a greater nocturnal noise in the bedroom was correlated with more impairments in subjective and objective sleep–wake variables while a lower 24-hour light exposure was associated with more disruption of subjectively assessed sleep only.

Conclusions Although longitudinal studies are needed to establish the etiology of sleep–wake difficulties in patients with advanced cancer, our findings suggest that physical symptoms, maladaptive sleep behaviours and environmental factors can contribute to their development or their persistence and need to be adequately addressed.

  • sleep-wake difficulties
  • palliative care
  • actigraphy
  • correlates
  • light exposure
  • environmental noise

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  • Contributors MSB and JS did the conception and the study’s design, the acquisition and interpretation of data, and writing of the manuscript. HI did the data analysis in collaboration with MSB. MA was involved in the conception and the study’s design as well as in the interpretation of data. MA also revised the final manuscript.

  • Funding This study was supported by training awards held by the first author from the Canadian Institutes of Health Research, the Fonds de recherche santé Québec and the Psychosocial Oncology Research Training Program, and a research grant held by the second and the third authors from the Équipe de recherche Michel-Sarrazin en oncologie psycho-sociale et soins palliatifs.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the research ethics committees of L’Hôtel-Dieu de Québec (L’HDQ; CHU de Québec–Université Laval) and Maison Michel-Sarrazin (MMS), a palliative care hospice in Quebec City.

  • Provenance and peer review Not commissioned; externally peer reviewed.