Exploring sleep disturbance among adults with primary or secondary malignant brain tumors and their caregivers

Prevalence, risk factors, and impacts of sleep disturbances in patients with primary brain tumors: a systematic review

Sleep disturbances are common in patients with primary brain tumors (PBT), significantly affecting their health-related quality of life (QoL), emotional well-being, cognitive function, and clinical outcomes. These disturbances not only impact the patients themselves but also place a burden on their families and caregivers. Despite growing recognition of these problems, a comprehensive understanding of their prevalence, severity, and risk factors remains limited. This systematic review aimed to update the evidence on sleep disturbances in PBT patients, focusing on prevalence, risk factors, and management strategies. Following PRISMA 2020 guidelines, we searched PubMed, EMBASE, Scopus, PsycINFO, and CINAHL for studies published from September 2015 to June 2024. Eligible studies assessed sleep disturbances in adult PBT patients using validated methods. Studies with mixed-cancer samples, pediatric patients, or lacking validated sleep assessments were excluded. A total of 11 studies were included, revealing high rates of sleep disturbances, ranging from 9.2% to over 60%, varying by tumor type and treatment stage. Key risk factors included older age, female gender, certain tumor types (e.g., pituitary), perioperative sleep quality, and psychological distress. Sleep disturbances were linked to worse clinical outcomes, including higher mortality and burden. Addressing sleep disturbances through routine assessment and targeted interventions is essential for improving outcomes in this population.

Circadian rhythm related genes signature in glioma for drug resistance prediction: a comprehensive analysis integrating transcriptomics and machine learning

BACKGROUND

Gliomas, 24% of all primary brain tumors, have diverse histology and poor survival rates, with about 70% recurring due to acquired or de novo resistance. Insomnia in patients is correlated strongly with circadian rhythm disruptions. The correlation between circadian rhythm disorders and drug resistance of some tumors has been proved. However, the precise mechanism underlying the relationship between glioma and circadian rhythm disorders has not been elucidated.

METHODS

Circadian rhythm-related genes (CRRGs) were identified using the least absolute shrinkage and selection operator (LASSO) regression, and stochastic gradient descent (SGD) was performed to form a circadian rhythm-related score (CRRS) model. The studies of immune cell infiltration, genetic variations, differential gene expression pattern, and single cell analysis were performed for exploring the mechanisms of chemotherapy resistance in glioma. The relationship between CRRGs and chemosensitivity was also confirmed by IC 50 (half maximal inhibitory concentration) analysis.

RESULT

Signatures of 16 CRRGs were screened out and identified. Based on the CRRS model, an optimal comprehensive nomogram was created, exhibiting a favorable potential for predicting drug resistance in samples. Immune infiltration, cell-cell communication, and single cell analysis all indicated that high CRRS group was closely related to innate immune cells. IC50 analysis showed that CRRG knockdown enhanced the chemosensitivity of glioma.

CONCLUSION

A significant correlation between CRRGs, drug resistance of glioma, and innate immune cells was found, which might hold a significant role in the drug resistance of glioma.

Social Determinants of Health Predict Sleep-Wake Disturbances Among Patients Living With Primary Brain Tumors: A Cross-Sectional Analysis

INTRODUCTION

Sleep disturbance (SD) and sleep-related impairment (SRI) significantly impact the lives of primary brain tumor (PBT) patients. We aimed to describe the prevalence of SD and SRI in this population, determine the reliability of the PROMIS-SD and PROMIS-SRI instruments, and identify predictive factors to support the development of targeted interventions for at-risk individuals.

METHODS

This cross-sectional study evaluated SD and SRI in PBT patients enrolled in a Natural History Study who completed 1-year follow-up questionnaires (N = 229). Demographic, clinical, and socioeconomic data were analyzed to identify factors associated with SD and SRI. Descriptive statistics were used to report the prevalence of sleep problems, and linear regression analysis was conducted to identify predictive factors. The reliability of sleep-related instruments was calculated using Cronbach's alpha.

RESULTS

Fifteen percent of PBT participants reported clinically significant SD and 20% reported clinically significant SRI, which were associated with financial toxicity (p < 0.001), being unemployed (p ≤ 0.02), and taking psychotropic medication (p ≤ 0.002). Good internal consistency was demonstrated by the SD (0.923) and SRI (0.925) questionnaires in this population.

CONCLUSIONS

In this study, social factors such as financial toxicity and employment status were associated with SD and SRI. Psychotropic medications also impacted SD and SRI in PTB survivors, but less so than financial toxicity. Social factors and other medications may impact sleep more strongly in PBT survivors than their previous treatment courses.

IMPLICATIONS FOR CANCER SURVIVORS

SD and SRI can be impacted by multiple factors, including those not related to PBT treatment, which should be considered by their providers.

Proposal for Managing Cancer-Related Insomnia: A Systematic Literature Review of Associated Factors and a Narrative Review of Treatment

OBJECTIVE

Insomnia is common in patients with cancer. It has a multifactorial etiology that may include the disease process, adverse effects of anticancer therapies, and/or an association with other comorbidities. The purpose of this review was to identify risk factors for insomnia and suggest optimal management strategies.

METHODS

We conducted a systematic literature review to elucidate the risk factors for insomnia and sleep disturbances in patients with solid tumors. The effects of sleep medications in this population were also described.

RESULTS

A total of 75 publications were evaluated, including those on breast, lung, gynecologic, brain, head and neck, gastrointestinal, prostate, thyroid, and mixed cancers. We classified the factors related to insomnia or sleep disturbance in cancer into four categories: (1) patient demographic characteristics (e.g., age, marital or socioeconomic status); (2) mental state (e.g., depression or anxiety); (3) physical state (e.g., fatigue, pain, or restless legs syndrome); and (4) anticancer treatment-related (e.g., use of chemotherapy, opioids, or hormone therapy). Overall, literature on the pharmacologic treatment of insomnia is extremely limited, although some efficacy data for zolpidem and melatonin have been reported.

CONCLUSIONS

Demographic characteristics, physical and mental distress, and anticancer treatments are all risks for insomnia in patients with cancer. The limited evidence base for pharmacologic therapy in this patient population means that healthcare professionals need to implement a comprehensive and multidisciplinary pathway from screening to management.

Telehealth group Cognitive-Behavioral Therapy for Insomnia (CBT-I) in primary brain tumor: Primary outcomes from a single-arm phase II feasibility and proof-of-concept trial

BACKGROUND

Cognitive-Behavioral Therapy for Insomnia (CBT-I), the frontline treatment for insomnia, has yet to be evaluated among patients with primary brain tumors (PwPBT) despite high prevalence of sleep disturbance in this population. This study aimed to be the first to evaluate the feasibility, safety, and acceptability of implementing telehealth group CBT-I as well as assessing preliminary changes in subjective sleep metrics in PwPBT from baseline to follow-up.

METHODS

Adult PwPBT were recruited to participate in six 90-min telehealth group CBT-I sessions. Feasibility was assessed by rates of screening, eligibility, enrollment, and data completion. Safety was measured by participant-reported adverse events. Acceptability was assessed by retention, session attendance, satisfaction, recommendation of program to others, and qualitative feedback. Participant subjective insomnia severity, sleep quality, and fatigue were assessed at baseline, post intervention, and 3-month follow-up.

RESULTS

Telehealth group CBT-I was deemed safe. Following the 76% screening rate, 85% of interested individuals met study eligibility and 98% enrolled (N = 44). Ninety-one percent of enrolled participants completed measures at baseline, 79% at post intervention, and 73% at 3-month follow-up. Overall, there was an 80% retention rate for the 6-session telehealth group CBT-I intervention. All participants endorsed moderate-to-strong treatment adherence and 97% reported improved sleep. Preliminary pre-post intervention effects demonstrated improvements in subjective insomnia severity, sleep quality, and fatigue with large effect sizes. These effects were maintained at follow-up.

CONCLUSIONS

Results of this proof-of-concept trial indicate that telehealth group CBT-I is feasible, safe, and acceptable among PwPBT, providing support for future randomized controlled pilot trials.

Global prevalence of poor sleep quality in cancer patients: A systematic review and meta-analysis

OBJECTIVE

Poor sleep quality is common in patients with cancer, but the prevalence rates varied widely across studies. This systematic review and meta-analysis examined the pooled prevalence of poor sleep quality among patients with cancer.

METHODS

Systematic literature searches were independently conducted in the major databases (Web of Science, PubMed, EMBASE and PsycINFO). Studies that reported the prevalence of poor sleep quality in patients with cancer were analyzed using a random effects model. Funnel plots and Egger's tests were used to assess publication bias. Statistical analyses were performed using R software.

RESULTS

A total of 59 epidemiological studies involving 16,223 patients were included. The pooled prevalence of poor sleep quality in patients with cancer was 57.4% [95% confidence interval (CI): 53.3% - 61.6%]. Additionally, three comparative studies with 372 patients and 412 healthy controls were included. Compared to healthy controls, patients with cancer had a significantly higher risk for poor sleep quality [odd ratio (OR) = 3.0; 95%CI: 1.2-7.2; P < 0.05]. Subgroup analyses of the studies revealed that studies from Middle East & North Africa region and low income countries, and on gynecological cancer as well as those with a lower cut-off value of sleep quality (all P < 0.01) reported a higher prevalence of poor sleep quality. Meta-regression analyses showed that higher prevalence of poor sleep quality was associated with higher prevalence of comorbid depression (P < 0.05) and anxiety (P < 0.01), but was associated with a lower education level (P < 0.05) and alcohol use ratio (P < 0.05).

CONCLUSION

Poor sleep quality is common among patients with cancer. Considering the overall high prevalence rate and negative impact of poor sleep quality, appropriate measures to identify and improve poor sleep quality are needed to enhance the clinical outcomes in this group.

Impact of Preoperative Sleep Disturbances on Postoperative Delirium in Patients with Intracranial Tumors: A Prospective, Observational, Cohort Study

Background

Postoperative delirium (POD) is prevalent in craniotomy patients and is associated with high mortality. Sleep disturbances are receiving increasing attention from clinicians as associated risk factors for postoperative complications. This study aimed to determine the impact of preoperative sleep disturbances on POD in craniotomy patients.

Methods

We recruited 130 patients undergoing elective craniotomy for intracranial tumors between May 1st and December 30th, 2022. Preoperative subjective sleep disturbances were assessed using the Pittsburgh Sleep Quality Index on the day of admission. We also measured objective perioperative sleep patterns using a dedicated sleep monitoring device 3 days before and 3 days after the surgery. POD was assessed twice daily using the Confusion Assessment Model for the Intensive Care Unit within the first week after craniotomy.

Results

Preoperative sleep disturbances were diagnosed in 49% of the study patients, and POD was diagnosed in 22% of all the study patients. Sleep disturbances were an independent risk factor for POD (OR: 2.709, 95% CI: 1.020-7.192, P = 0.045). Other risk factors for POD were age (OR: 3.038, 95% CI: 1.195-7.719, P = 0.020) and the duration of urinary catheterization (OR: 1.246, 95% CI: 1.025-1.513, P = 0.027). Perioperative sleep patterns (including sleep latency, deep sleep duration, frequency of awakenings, apnea-hypopnea index, and sleep efficiency) were significantly associated with POD.

Conclusion

This study demonstrated that preoperative sleep disturbances predispose patients undergoing craniotomy to POD, also inferred a correlation between perioperative sleep patterns and POD. The targeted screening and intervention specifically for sleep disturbances during the perioperative period are immensely required.

Prevalence and management of sleep disturbance in adults with primary brain tumours and their caregivers: a systematic review

PURPOSE

The aims of this systematic review were to (1) examine the prevalence, severity, manifestations, and clinical associations/risk factors of sleep disturbance in primary brain tumour (PBT) survivors and their caregivers; and (2) determine whether there are any sleep-focused interventons reported in the literature pertaining to people affected by PBT.

METHODS

This systematic review was registered with the international register for systematic reviews (PROSPERO: CRD42022299332). PubMed, EMBASE, Scopus, PsychINFO, and CINAHL were electronically searched for relevant articles reporting sleep disturbance and/or interventions for managing sleep disturbance published between September 2015 and May 2022. The search strategy included terms focusing on sleep disturbance, primary brain tumours, caregivers of PBT survivors, and interventions. Two reviewers conducted the quality appraisal (JBI Critical Appraisal Tools) independently, with results compared upon completion.

RESULTS

34 manuscripts were eligible for inclusion. Sleep disturbance was highly prevalent in PBT survivors with associations between sleep disturbance and some treatments (e.g., surgical resection, radiotherapy, corticosteroid use), as well as other prevalent symptoms (e.g., fatigue, drowsiness, stress, pain). While the current review was unable to find any sleep-targeted interventions, preliminary evidence suggests physical activity may elicit beneficial change on subjectively reported sleep disturbance in PBT survivors. Only one manuscript that discussed caregivers sleep disturbance was identified.

CONCLUSIONS

Sleep disturbance is a prevalent symptom experienced by PBT survivors, yet there is a distinct lack of sleep-focused interventions in this population. This includes a need for future research to include caregivers, with only one study identified. Future research exploring interventions directly focused on the management of sleep disturbance in the context of PBT is warranted.

Exploring the prevalence and burden of sleep disturbance in primary brain tumor patients

BACKGROUND

Sleep disturbance (SD) is common in patients with cancer and has been associated with worse clinical outcomes. This cross-sectional study explored the prevalence of SD in a primary brain tumor (PBT) population, identified associated demographic and clinical characteristics, and investigated co-occurrence of SD with other symptoms and mood disturbance.

METHODS

Demographic, clinical characteristics, MD Anderson Symptom Inventory-Brain Tumor, and Patient Reported Outcome Measurement Information System Depression and Anxiety Short-Forms were collected from PBT patients at study entry. Descriptive statistics, Chi-square tests, and independent t-tests were used to report results.

RESULTS

The sample included 424 patients (58% male, 81% Caucasian) with a mean age of 49 years (range 18-81) and 58% with high-grade gliomas. Moderate-severe SD was reported in 19% of patients and was associated with younger age, poor Karnofsky Performance Status, tumor progression on MRI, and active corticosteroid use. Those with moderate-severe SD had higher overall symptom burden and reported more moderate-severe symptoms. These individuals also reported higher severity in affective and mood disturbance domains, with 3 to 4 times higher prevalence of depressive and anxiety symptoms, respectively. The most frequently co-occurring symptoms with SD were, drowsiness, and distress, though other symptoms typically associated with tumor progression also frequently co-occurred.

CONCLUSIONS

PBT patients with moderate-severe SD are more symptomatic, have worse mood disturbance, and have several co-occurring symptoms. Targeting interventions for sleep could potentially alleviate other co-occurring symptoms, which may improve life quality for PBT patients. Future longitudinal work examining objective and detailed subjective sleep reports, as well as underlying genetic risk factors, will be important.

Study of the Economic, Environmental, and Social Factors Affecting Chinese Residents' Health Based on Machine Learning

The Healthy China Strategy puts realistic demands for residents' health levels, but the reality is that various factors can affect health. In order to clarify which factors have a great impact on residents' health, based on China's provincial panel data from 2011 to 2018, this paper selects 17 characteristic variables from the three levels of economy, environment, and society and uses the XG boost algorithm and Random forest algorithm based on recursive feature elimination to determine the influencing variables. The results show that at the economic level, the number of industrial enterprises above designated size, industrial added value, population density, and per capita GDP have a greater impact on the health of residents. At the environmental level, coal consumption, energy consumption, total wastewater discharge, and solid waste discharge have a greater impact on the health level of residents. Therefore, the Chinese government should formulate targeted measures at both economic and environmental levels, which is of great significance to realizing the Healthy China strategy.

Sleep disturbance in primary brain tumor: prevalence, risk factors, and patient preferences

PURPOSE

Primary brain tumor (PBT) patients report sleep disturbance due to their disease and treatment, yet few studies have utilized validated measures to understand the extent of patients' concerns and preferences for treatment. The purpose of this quality improvement project was to determine the prevalence and associated risk factors of sleep disturbance among PBT patients in our clinic and to evaluate interest in treatment for sleep disturbance.

METHODS

PBT patients completed validated measures of sleep disturbance and health during routine neuro-oncology visits. Patients also reported on sleep-related symptom management and their preferences for pharmacological and/or behavioral treatment.

RESULTS

Sleep disturbance was common, with 61.5% of PBT patients (N = 119; Mage = 52.60 years; 50% male) reporting poor sleep quality and 21.5% endorsing symptoms of insomnia. Insomnia could be explained by increased fatigue and corticosteroid use; sleep quality could be explained by fatigue. Patients in our clinic with higher grade tumors, significant sleep disturbance, of minority racial/ethnic status, and those not already taking sleep medications were more likely to report their symptoms and were not well-addressed by their medical team. Patients indicated a similar interest in pharmacological and behavioral treatment, warranting the availability of both in our clinic.

CONCLUSIONS

Findings indicate a high prevalence of sleep disturbance in PBT patients, highlighting the need for increased screening, monitoring, and treatment in our neuro-oncology clinic. Future research would benefit from assessing the efficacy of behavioral treatments for sleep disturbance in this population.

Sleep disturbance in cancer patients referred to an ambulatory integrative oncology consultation

BACKGROUND

Sleep disturbance (SD) is highly prevalent in oncology and negatively affects quality of life and mortality. Evidence supports the use of integrative oncology (IO) practices to treat SD, but there is limited published data on the characteristics of SD and factors associated with SD in IO. We determined the prevalence, severity, and factors associated with SD among cancer patients seen in an ambulatory IO consultation.

METHODS

Patients with cancer referred for initial outpatient IO consultation in 2017 were eligible. Patient demographics, clinical characteristics, and patient-reported outcomes (Edmonton Symptom Assessment Scale (ESAS), Measure Yourself Concerns and Wellbeing (MYCaW), PROMIS-10) were retrospectively reviewed.

RESULTS

One thousand five hundred twenty patients were included in the analysis. The majority (70%) were women with breast cancer (42%). Nine hundred seventy-one (64%) patients reported significant SD with ESAS Sleep ≥ 4, yet only 11% expressed poor sleep as their primary or secondary concern for the IO consultation. The median SD (IQR) was 5 (3,7). ESAS scores for fatigue (adjusted OR 1.16; CI 1.07-1.26, p < 0.001), pain (adjusted OR 1.07; CI 1.00-1.15, p < 0.05), hot flashes (adjusted OR 1.14; CI 1.07-1.22, p < 0.001), well-being (adjusted OR 1.33; CI 1.22-1.46, p < 0.001), and psychological distress score (anxiety and depression) (adjusted OR 1.16; CI 1.01-1.11, p < 0.01) were independently associated with SD in multivariate analysis. Acupuncture was the most frequent intervention prescribed, 175 (35%). Other modalities included oncology massage (15%), health psychology (5%), and meditation (1%).

CONCLUSIONS

Although 64% of patients seeking IO consultation reported clinically significant SD, only 11% were seeking integrative approaches for managing SD. ESAS fatigue, hot flashes, well-being, and psychological symptoms were significantly associated with SD.

Prevalence, correlates, and impact of sleep disturbance in Chinese meningioma patients

PURPOSE

Sleep disturbance is common in meningioma patients and may lead to disease aggravation and decreases health-related quality of life (HRQoL). However, the sleep quality of meningioma patients newly diagnosed and ready for surgery has not been well clarified in China. This study aims to evaluate the prevalence, correlates, and impact of sleep disturbance among Chinese meningioma patients.

METHODS

In this cross-sectional study, meningioma patients were recruited from the Affiliated Hospital of Nantong University from January 2020 to November 2020. A series of questionnaires were applied: the 0-10 Numerical Rating Scale (NRS), the Hospital Anxiety and Depression Scale (HADS), the Multidimensional Fatigue Inventory (MFI-20), the Epworth Sleepiness Scale (ESS), the Short-Form 36 (SF-36), the Pittsburgh Sleep Quality Index (PSQI). Independent samples t test, Mann-Whitney U test, chi-square analysis, Pearson/Spearman correlation, and binary logistic regression were used to analyze the data.

RESULTS

One hundred meningioma patients completed the questionnaires. Sleep disturbance affected 43% of the meningioma patients and was linked to many concomitant symptoms, such as headache, fatigue, anxiety, and depression. Binary logistic regression indicated that fatigue and headache were independently associated with sleep disturbance of meningioma patients. Meanwhile, severe sleep disturbance led to lower quality of life.

CONCLUSIONS

These findings demonstrated that a considerable number of meningioma patients newly diagnosed and ready for surgery suffered from sleep disturbance, potentially contributing to impair HRQoL. Medical personnel should pay more attention to meningioma patients with sleep disturbance and take effective measures to improve sleep quality, with the ultimate goal to improve their HRQoL.

Understanding sleep disturbance in the context of malignant brain tumors: a qualitative analysis

Background

Sleep is an important element in health-related quality of life of cancer patients and caregivers. This study aimed to explore the experience of sleep disturbance in people with malignant brain tumors (BT) and their family caregivers.

Methods

Participants were recruited from ambulatory neuro-oncology clinics. Semi-structured interviews were conducted with 24 patients (67% with high-grade gliomas) and 14 caregivers. Data were analyzed thematically using a framework synthesis.

Results

We identified six themes relating to perceptions of the nature, impact, causal factors, and interventions for sleep disturbance, beliefs about sleep and impact, and personal coping strategies. Participants described their sleep disturbance in terms of insomnia symptoms; most commonly difficulties initiating and maintaining sleep. Participants had varied views on causal factors including the BT diagnosis and treatment and caregiver burden. However, excessive thinking and BT-related anxiety were evident in both patients and caregivers. The described impact on daytime functioning due to non-restful sleep and fatigue appeared to be significant and many participants needed daytime naps, although they understated the impact on individual functioning. Some participants were reluctant to seek help from clinicians for sleep disturbance due to previous experiences where sleep disturbance was overlooked, or because they held negative views toward pharmacological interventions. Participants reported various coping strategies, ranging from relaxation-promoting techniques to behaviors to distract thinking at night that may instead disturb sleep.

Conclusions

Psychological factors contribute to sleep disturbance in patients with BT and caregivers. This population may benefit from information about sleep disturbance and interventions targeting anxiety.