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Observational study of sleep disturbances in advanced cancer
  1. Andrew Neil Davies1,
  2. Shuchita D Patel1,
  3. Amanda Gregory2 and
  4. Bernadette Lee3
  1. 1 Supportive and Palliative Care, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
  2. 2 St. Catherine’s Hospice, Crawley, UK
  3. 3 Woking and Sam Beare Hospices, Woking, UK
  1. Correspondence to Dr Andrew Neil Davies, Supportive and Palliative Care, Royal Surrey County Hospital NHS Foundation Trust, Guildford GU2 7XX, UK; adavies12{at}


Objectives To determine the prevalence of nightmares, sleep terrors and vivid dreams in patients with advanced cancer (and the factors associated with them in this group of patients).

Methods The study was a multicentre, prospective observational study. Participants were patients with locally advanced/metastatic cancer, who were under the care of a specialist palliative care team. Data were collected on demographics, cancer diagnosis, cancer treatment, current medication, performance status, sleep quality (Pittsburgh Sleep Quality Index), dreams and nightmares, and physical and psychological symptoms (Memorial Symptom Assessment Scale-Short Form).

Results 174 patients completed the study. Sleep quality was poor in 70.5% participants and was worse in younger patients and in inpatients (hospital, hospice). 18% of patients reported nightmares, 8% sleep terrors and 34% vivid dreams. Nightmares were associated with poor sleep quality and greater sleep disturbance; nightmares were also associated with greater physical and psychological burden. Nightmares (and vivid dreams) were not associated with the use of opioid analgesics.

Conclusions Nightmares do not seem to be especially common in patients with advanced cancer, and when they do occur, there is often an association with sleep disturbance, and/or physical and psychological burden.

  • cancer
  • palliative care
  • sleep disturbance
  • nightmares
  • sleep terrors
  • vivid dreams

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  • Contributors AND conceived the study. AND and SDP wrote the protocol. SDP, AG and BL were responsible for data collection. AND and SDP wrote the first draft of the manuscript. AG and BL reviewed the manuscript.

  • Funding This study was funded by the Supportive and Palliative Care Research Fund at Royal Surrey County Hospital NHS Foundation Trust.

  • Competing interests None declared.

  • Ethics approval NRES Committee London—Bloomsbury.

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