Table 1
Distribution of demographic/clinical traits by site and summary of PSQI scores
| 1A | ||||
|---|---|---|---|---|
| All Patients | Inpatients | Outpatients | Site Effect | |
| Demographic/Clinical | (n = 84) | (n = 42) | (n = 42) | (χ2, p)a |
| Age in years (Mean; Range) | 62 (40-94) | 57(40-78) | 66(47-94) | 4.0, <0.01 |
| Sex (M:F)b | 65:19 | 23:19 | 42:00:00 | 24.6, <0.01 |
| Cancer Stage (IIB:IIIA&B: IV)b | 1:18:65 | 0:10:32 | 1:08:33 | NS |
| Prior Therapy (Yes:No)b | 31:52 | 21:20 | 10:32 | NS |
| WHO ECOG (0:1:2)b | 30:42:11 | 17:18:07 | 13:24:04 | NS |
| COPD (No: Mild: Mod: Severe) | ND | ND | 14:7:13:8 | ND |
| 1B | ||||
| All Patients | Inpatients | Outpatients | Site Effect | |
| PSQI Sleep Factor | (n = 64) | (n = 37) | (n = 35) | (t, p ) a |
| Sleep Quality | 1.40 ± 0.11 | 1.23 ± 0.14 | 1.56 ± 0.16 | NS |
| Sleep Latency | 1.48 ± 0.12 | 1.46 ± 0.16 | 1.50 ± 0.18 | NS |
| Sleep Duration | 1.63 ± 0.14 | 1.62 ± 0.20 | 1.63 ± 0.20 | NS |
| Sleep Efficiency | 1.65 ± 0.16 | 1.57 ± 0.23 | 1.74 ± 0.21 | NS |
| Sleep Disturbance | 2.11 ± 0.12 | 1.80 ± 0.17 | 2.30 ± 0.15 | 5.6, 0.02 |
| Sleep Medication | 0.78 ± 0.12 | 0.81 ± 0.17 | 0.75 ± 0.17 | NS |
| Daytime Dysfunction | 1.34 ± 0.13 | 1.16 ± 0.16 | 1.52 ± 0.20 | NS |
| Global Sleep Quality Score | 11.19 ± 0.66 | 10.86 ± 0.93 | 11.54 ± 0.94 | NS |
a Based on t-test (t, p-value). b Values are numbers of patients. c Owen et al (1999) 26, 1649-51; NS = not significant; ND = no data available
a Based on t-test (t, p-value)
Figure 1
PSQI-measured sleep quality differences between inpatients, outpatients and healthy controls. Lung cancer patients demonstrate poorer sleep quality, quantity and more daytime dysfunction when compared to healthy subjects.
Figure 2
Among both inpatients and outpatients, the relationship between ECOG performance status and PSQI domain score in daytime dysfunction worsened with worsening performance status score.
Table 2
Actigraphic activity-sleep characteristics during the wake period and sleep period of non-small cell lung cancer patients compared to population-based controls
| Wake Period | Sleep Period | By Site | ||||
|---|---|---|---|---|---|---|
| Actigraphic Parameters | All patients | Population controls | All patients | Population controls | Inpatients | Outpatients |
| Cases | 68 | 35 | 68 | 35 | 35 | 33 |
| Mean activity(accel/min) | 126.9 ± 4.9* | 182.6 ± 25 | ND | ND | 111.7 ± 7.1 | 143.0 ± 5.6 |
| Wake minutes | 797.5 ± 26* | 947.1 ± 10.9 | 95.0 ± 8.8* | 31.1 ± 3.6 | 714.2 ± 36 | 885.8 ± 31 |
| Sleep minutes | 208.8 ± 18* | 47.1 ± 10.9 | 284.0 ± 18.3* | 417.8 ± 9.4 | 241.3 ± 25 | 174.4 ± 24 |
| % Sleep | 20.9 ± 1.8* | 4.7 ± 0.7 | 72.5 ± 2.0* | 93.0 ± 0.8 | 25.8 ± 2.8 | 15.6 ± 1.9 |
| Duration of longest sleep (min) | 43.0 ± 2.8* | 23.6 ± 0.6 | 91.7 ± 7.4* | 225.6 ± 17 | 45.4 ± 4.0 | 40.5 ± 3.9 |
| Sleep Latency | NA | NA | 20.8 ± 2.5* | 12.1 ± 6.9 | NA | NA |
| Sleep Efficiency | NA | NA | 79.8 ± 1.7* | 95.9 ± 0.7 | NA | NA |
*p < 0.05 compared to controls
Figure 3
Objective actigraphic parameters that illustrate daytime dysfunction among cancer patients when compared to healthy controls.
Table 3
Correlation of PSQI components and Actigraphy during the Usual Wake Period by Sitea
| Actigraphy Parameters (Wake Period) | PSQI Sleep Medicine Use | PSQI Daytime Dysfunction | Global PSQI Score |
|---|---|---|---|
| Inpatients (n = 35) | |||
| Activity Mean | ns | ns | ns |
| Sleep Minutes | 0.39(0.05) | ns | ns |
| % Sleep | -0.37(0.064) | ns | ns |
| Wake Episodes | ns | ns | ns |
| Mean Wake Episode | ns | ns | ns |
| Long Wake Episode | ns | -0.46(0.03) | ns |
| Sleep Episodes | ns | ns | ns |
| Mean Sleep Episode | -0.41(0.035) | ns | ns |
| Long Sleep Episode | ns | ns | ns |
| Longest Sleep Episode | -0.41(0.04) | ns | ns |
| Outpatients (n = 33) | |||
| Activity Mean | -0.58(0.003) | -0.61(0.006) | -0.48(0.014) |
| Sleep Minutes | ns | 0.54(0.017) | 0.41(0.036) |
| % Sleep | ns | 0.45(0.053) | 0.37(0.06) |
| Wake Episodes | 0.40(0.047) | ns | ns |
| Mean Wake Episode | -0.52(0.008) | ns | -0.43(0.027) |
| Long Wake Episode | 0.34(0.096) | ns | ns |
| Sleep Episodes | 0.40(0.047) | ns | 0.35(0.078) |
| Mean Sleep Episode | ns | 0.62(0.004) | ns |
| Long Sleep Episode | ns | 0.46(0.047) | 0.43(0.029) |
| Longest Sleep Episode | ns | 0.61(0.005) | 0.45(0.02) |
a Correlations are shown only for p-values < 0.05; ns = not significant; p-values are in ( ).
Figure 4
Relationship of Subjective (PSQI) and Objective (Actigraphy) assessments of activity (A) and wakefulness during sleep (B). Correlations between the two assessments are the most robust among outpatients, while actigraphic parameters were potentially masked in inpatients.
Table 4
Correlation of PSQI components and Actigraphy during the Usual Sleep Period
| Actigraphy Parameters (Sleep Period) | PSQI Sleep Disturbance | PSQI Sleep Medicine Use | PSQI Daytime Dysfunction | Global PSQI Score |
|---|---|---|---|---|
| Inpatients (n = 35) | ||||
| Wake Minutes | ns | 0.44 (0.025) | ns | ns |
| Wake Episodes | ns | 0.34 (0.09) | ns | ns |
| Mean Wake Episode | ns | 0.40 (0.043) | ns | ns |
| Long Wake Episode | ns | 0.47 (0.014) | ns | ns |
| Longest Wake Episode | ns | 0.41 (0.038) | ns | ns |
| Wake After Sleep Onset | ns | 0.35 (0.077) | ns | ns |
| Sleep Latency | ns | 0.62 (< 0.001) | ns | ns |
| Sleep Efficiency | ns | ns | ns | ns |
| Sleep Episodes | ns | 041 (0.038) | ns | ns |
| Long Sleep Episode | ns | ns | ns | ns |
| Outpatients (n = 33) | ||||
| Wake Minutes | ns | ns | ns | ns |
| Wake Episodes | 0.63 (0.005) | ns | 0.55 (0.015) | 0.49 (0.01) |
| Mean Wake Episode | ns | ns | ns | ns |
| Long Wake Episode | ns | -0.43 (0.031) | ns | ns |
| Longest Wake Episode | ns | ns | ns | ns |
| Wake After Sleep Onset | ns | ns | ns | -0.46 (0.018) |
| Sleep Latency | ns | -0.38 (0.058) | ns | ns |
| Sleep Efficiency | ns | ns | ns | ns |
| Sleep Episodes | -0.63 (0.005) | ns | -0.57 (0.011) | -0.49 (0.011) |
| Long Sleep Episode | -0.53 (0.023) | ns | -0.47 (0.043) | -0.41 (0.035) |
a Correlations are shown only for p-values < 0.05; ns = not significant; p-values are in ( ).
Table 5
Correlations of PSQI Components and Actigraphy Parameters of Circadian Organization for Inpatients and Outpatientsa
| Actigraphy Parameters (Circadian) | PSQI Sleep Duration | PSQI Sleep Efficiency | PSQI Sleep Disturbance | PSQI Sleep Medicine | PSQI Daytime Dysfunction | PSQI Overall PSQI |
|---|---|---|---|---|---|---|
| Inpatients(n = 35) | ||||||
| 24 HR rhythm Mean | ns | ns | ns | ns | ns | ns |
| 24 HR rhythm Amplitude | ns | ns | ns | ns | ns | ns |
| Peak Activity | ns | ns | ns | ns | ns | ns |
| Circadian Quotient | ns | ns | ns | ns | ns | ns |
| Rhythm Quotient | ns | ns | ns | ns | ns | ns |
| Day-Night Activity Balance | ns | ns | -0.61 (0.037) | ns | ns | ns |
| Day-Night Wake Balance | ns | 0.4(0.03) | ns | ns | ns | ns |
| Day-Night Sleep Balance | -0.43 (0.016) | ns | ns | 0.46 (0.018) | ns | ns |
| Night Day Long Sleep Balance | 0.37 (0.039) | ns | ns | ns | ns | ns |
| Night Day Longest Sleep Balance | -0.38 (0.03) | ns | ns | ns | ns | ns |
| Night-Day Sleep Balance | ns | ns | ns | ns | ns | ns |
| Outpatients (n = 33) | ||||||
| 24 HR rhythm Mean | ns | ns | ns | -0.45 (0.02) | ns | ns |
| 24 HR rhythm Amplitude | ns | ns | ns | -0.45 (0.048) | ns | |
| Peak Activity | ns | ns | ns | -0.45 (0.048) | ns | ns |
| Circadian Quotient | ns | ns | ns | ns | -0.42 (0.065) | ns |
| Rhythm Quotient | ns | ns | ns | ns | -0.58 (0.007) | ns |
| Day-Night Activity Balance | ns | ns | -0.61 (0.037) | ns | ns | ns |
| Day-Night Wake Balance | ns | 0.36 (0.08) | ns | ns | ns | ns |
| Day-Night Sleep Balance | 0.43 (0.027) | ns | ns | ns | -0.62 (0.004) | -0.49 (0.01) |
| Night Day Long Sleep Balance | 0.37 (0.063) | ns | -0.42 (0.08) | ns | -0.64 (0.003) | -0.52 (0.006) |
| Night Day Longest Sleep Balance | 0.43 (0.028) | ns | ns | ns | -0.51 (0.027) | -0.4 (0.044) |
| Night-Day Sleep Balance | ns | ns | -0.44 (0.067) | -0.37 (0.07) | -0.43 (0.065) | -0.36 (0.071) |
a Correlations are shown only for p-values < 0.05; ns = not significant; p-values are in ( ).
Table 6
Correlation of Circadian Actigraphy Parameters and PSQI of NSCLC Patients
| Actigraphy Parameters | Pittsburgh Sleep Quality Index | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Sleep Duration | Sleep Disturbance | Sleep Medicine Use | PSQI Daytime Dysfunction | Global Score | ||||||
| Inpatients (n = 35) | Outpatients (n = 33) | Inpatients (n = 35) | Outpatients (n = 33) | Inpatients (n = 35) | Outpatients (n = 33) | Inpatients (n = 35) | Outpatients (n = 33) | Inpatients (n = 35) | Outpatients (n = 33) | |
| Wake Span | ||||||||||
| Activity Mean | 0.07 | -0.58(0.003) | -0.25 | -0.61(0.006) | -0.11 | -0.48(0.014) | ||||
| Sleep Minutes | 0.39(0.05) | -0.36 | 0.09 | 0.54(0.017) | 0.26 | 0.41(0.036) | ||||
| Mean Wake Episode | 0.05 | -0.52(0.008) | -0.29 | 0.23 | -0.11 | -0.43(0.027) | ||||
| Sleep Episodes | -0.12 | 0.40(0.047) | 0.18 | 0.28 | 0.08 | 0.35(0.078) | ||||
| Mean Sleep Episode | -0.41(0.035) | -0.08 | -0.31 | 0.62(0.004) | 0.18 | 0.26 | ||||
| Sleep Span | ||||||||||
| Wake Episodes | 0.37 | 0.63 (0.005) | 0.34 (0.09) | -0.23 | 0.25 | 0.55 (0.015) | -0.32 | 0.49 (0.01) | ||
| Sleep Latency | 0.13 | 0.29 | 0.62 (< 0.001) | -0.38 (0.058) | 0.11 | -0.21 | -0.04 | 0.26 | ||
| Sleep Efficiency | -0.34 | 0.02 | -0.35 | 0.31 | 0.02 | 0.01 | 0.12 | 0.22 | ||
| Sleep Episodes | 0.37 | -0.63 (0.005) | 041 (0.038) | -0.24 | 0.25 | -0.57 (0.011) | -0.28 | -0.49 (0.011) | ||
| Circadian Parameters | ||||||||||
| 24 HR rhythm Mean | -0.45 (0.02) | |||||||||
| Circadian Quotient | -0.42 (0.065) | |||||||||
| Rhythm Quotient | -0.58 (0.007) | |||||||||
| Day-Night Activity Balance | -0.61 (0.037) | |||||||||
| Day-Night Sleep Balance | 0.43 (0.027) | 0.46 (0.018) | -0.62 (0.004) | -0.49 (0.01) | ||||||
| Night Day Long Sleep Balance | 0.37 (0.063) | -0.42 (0.08) | -0.64 (0.003) | -0.52 (0.006) | ||||||
a Correlations are shown only for p-values < 0.05; NSCLC = non-small cell lung cancer
Figure 5
Actigraphy pattern of two patients who had normal and abnormal PSQI Global Sleep Scores. The 24 hr pattern of activity of a lung cancer patient who had an overall PSQI Global Sleep Score of 2 (normal, upper curve) is more rhythmic than the flattened daily activity pattern of a patient who scored 21 (abnormal, lower curve) on the overall PSQI Global Score.