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Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item
  1. Sriram Yennurajalingam1,
  2. Dave Balachandran2,
  3. Sandra L Pedraza Cardozo1,
  4. Elyssa A Berg1,
  5. Gary B Chisholm3,
  6. Akhila Reddy1,
  7. Vera DeLa Cruz1,
  8. Janet L Williams1 and
  9. Eduardo Bruera1
  1. 1Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA
  2. 2Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3The University of Texas MD Anderson Cancer Center, Biostatistics, Houston, Texas, USA
  1. Correspondence to Dr Sriram Yennurajalingam, Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd. Houston, TX 77030, USA; syennu{at}


Aims Sleep Disturbance (SD) is a severe debilitating symptom in advanced cancer patients (ACP). However, routine screening of SD is uncommon. The primary aim of this study was to determine the optimal cutoff score for SD screening for Edmonton Symptom Assessment system (ESAS) sleep item using Pittsburgh Sleep Quality Index (PSQI) as a gold standard. We also determined the frequency of SD, obstructive sleep apnea symptoms (OSA) and restless leg syndrome (RLS) and factors associated with SD.

Methods We prospectively surveyed 180 consecutive ACP. Patients completed validated assessment for symptoms. We determined epidemiological performance, receiver operating characteristics, and correlations of SD.

Results SD according to PSQI was diagnosed in 112/180 (62%), and median (IQR) ESAS sleep was 5 (2-7). ESAS sleep ≥ 4 had a sensitivity of 74% and 80%, and specificity of 71% and 64% in the training and validation samples, respectively for screening of SD. The frequency of OSA was 61%; RLS was 38%. ESAS sleep was associated [r, p-value] with PSQI (0.61, <0.0001), pain (0.4, <0.0001); fatigue (0.35, <0.0001); depression (0.20, 0.006); anxiety (0.385, <0.0001); drowsiness (0.385, <0.0001), shortness of breath (0.24, <0.0014); anorexia (0.32, <0.0001), well-being (0.36, <0.0001). Multivariate analysis found well-being (OR per point 1.34, p=0.0003), pain (OR 1.21, p<0.0037), dyspnea (OR 1.16, p=0.027), and OSA (OR 0.31, P=0.003) as independent predictors of SD. There was no association between SD and survival.

Conclusions SD is frequent and ESAS SD item ≥ 4 has good sensitivity for SD screening.

  • Cancer
  • Symptoms and symptom management
  • Supportive care
  • Quality of life
  • Clinical assessment

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