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Follow-up assessment of sleep-related symptoms in patients after treatment for cancer: responses to continuous positive airway pressure treatment for co-morbid obstructive sleep apnoea

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

To assess changes in sleep-related symptoms in patients with breast cancer, endometrial cancer and melanoma previously examined for sleep-related symptoms and the presence of PSG (polysomnography)-determined OSA, ≥ 3 years post-treatment; and to evaluate how CPAP treatment affects sleep-related symptoms in patients previously diagnosed with OSA.

Methods

Patients initially recruited from breast cancer, endometrial cancer, and melanoma follow-up clinics at Westmead Hospital (Sydney, Australia) participated in this questionnaire-based study. Demographic and change in cancer status data were collected at follow-up. Patients completed the Pittsburgh Sleep Quality Index [poor sleep quality, PSQITOTAL ≥ 5au], Insomnia Severity Index, Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire; with ΔPSQITOTAL ≥ 3au indicating a clinically meaningful change in sleep quality over follow-up. PSG-determined OSA was confirmed using the apnoea-hypopnoea index. CPAP compliance was determined via self-report (CPAP compliant, CPAP; not compliant, non-CPAP). Logistic regression models determined if changes in cancer status, AHI, cancer subgroup or CPAP treatment was predictive of ΔPSQITOTAL ≥ 3 au and p < 0.05 indicated statistical significance.

Results

The 60 patients recruited had breast cancer (n = 22), endometrial cancer (n = 15), and melanoma (n = 23). Cancer subgroups were similarly aged, and all had median follow-up PSQITOTAL scores ≥ 5au; breast cancer patients scoring the highest (p < 0.05). The CPAP group had significantly reduced PSQITOTAL scores (p = 0.02) at follow-up, unlike the non-CPAP group. Cancer subgroups had similar median ISITOTAL, ESSTOTAL and FOSQ-10TOTAL scores at follow-up, regardless of CPAP treatment. There were no significant predictors of ΔPSQITOTAL ≥ 3 au at follow-up.

Conclusion

Sleep-related symptoms persist in patients with cancer ≥ 3 years after treatment, although these symptoms improve with CPAP. Future studies should evaluate how CPAP affects survival outcomes in cancer patients with comorbid OSA.

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Data availability

The datasets generated and analysed in the current study are available from the corresponding author, on reasonable request.

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Acknowledgements

The authors would like to thank Ayey Madut, Hong Man, Catherine Kennedy, Annie Stenlake, Masrura Kabir, Alissa Phung, Ragini Gengiah, Professor Christine L. Clarke, Associate Professor Nirmala Pathmanathan, Associate Professor James French, Dr Kristina Lindemann, Dr Robyn Sayers, Professor Paul Harnett, and Professor John Wheatley for their assistance with this study, alongside the Sydney West Translational Cancer Research Centre.

Funding

This study was funded by the Sydney West Translational Cancer Research Centre, Grant/Award Number: 15/TRC/1–01; Neil and Norma Hill Foundation; ResMed Foundation; Strategic Priorities Areas for Research Collaboration Grant from the University of Sydney.

Author information

Authors and Affiliations

  1. Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, Australia

    Harini Subramanian, Ritu Trivedi, Veronika Fuchsova, Terence Amis & Kristina Kairaitis

  2. Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia

    Veronika Fuchsova, Elisabeth Elder, Alison Brand, Julie Howle, Terence Amis & Kristina Kairaitis

  3. Breast Cancer Institute, Westmead Hospital, Westmead, Australia

    Elisabeth Elder

  4. Department of Gynaecological Oncology, Westmead Hospital, Westmead, Australia

    Alison Brand & Anna DeFazio

  5. Crown Princess Mary Cancer Centre, Westmead and Blacktown Hospitals, Blacktown, Australia

    Julie Howle

  6. Melanoma Institute Australia, The University of Sydney, Camperdown, Australia

    Julie Howle & Graham J. Mann

  7. Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, Australia

    Graham J. Mann & Anna DeFazio

  8. John Curtin School of Medical Research, Australian National University, Canberra, Australia

    Graham J. Mann

  9. The Daffodil Centre, The University of Sydney, Camperdown, Australia

    Anna DeFazio

  10. Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Australia

    Terence Amis & Kristina Kairaitis

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  1. Harini Subramanian
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Contributions

Harini Subramanian: Data curation (lead); formal analysis (lead); visualization (lead); writing – original draft (equal); writing – review and editing (lead). Ritu Trivedi: Data curation (supporting), investigation (lead), writing – review and editing (supporting). Veronika Fuchsova: Data curation (supporting); formal analysis (lead); investigation (supporting), writing – review and editing (supporting). Elisabeth Elder: Funding acquisition (supporting); resources (equal); writing – review and editing (supporting). Alison Brand: Funding acquisition (supporting); resources (equal); writing – review and editing (supporting). Julie Howle: Funding acquisition (supporting); resources (equal); writing – review and editing (supporting). Anna deFazio: Funding acquisition (supporting); resources (equal); writing – review and editing (supporting). Graham J Mann: Funding acquisition (supporting); resources (equal); writing – review and editing (supporting). Terence Amis: Conceptualization (equal); formal analysis (supporting); funding acquisition (lead); methodology (equal); project administration (equal); supervision (equal); visualization (supporting); writing – original draft (equal); writing – review and editing (lead). Kristina Kairaitis: Conceptualization (equal); formal analysis (supporting); funding acquisition (lead); methodology (equal); project administration (lead); supervision (equal); visualization (supporting); writing – original draft (equal); writing – review and editing (lead).

Corresponding author

Correspondence to Kristina Kairaitis.

Ethics declarations

The authors explicitly state that there are no conflicts of interest in relation to this article. Anna DeFazio declares receiving research grants and honoraria from AstraZeneca, although not in connection to the subject matter or materials discussed in this manuscript. Kristina Kairaitis declares receiving honoraria for sleep education from SomnoMed.

Ethics approval

Approval was obtained from the Western Sydney Local Health District Ethics Committee (HREC: AU RED LNR/18/WMEAD/418). Procedures used in this study adhere to the principles of the Declaration of Helsinki.

Consent to participate and publish

Informed consent was obtained from all individual participants included in the study. All participants signed informed consent regarding publishing their data.

Competing interests

The authors have no competing interests to declare, that are relevant to the content of this article. Anna DeFazio declares receiving research grants and honoraria from AstraZeneca, although not in connection to the subject matter or materials discussed in this manuscript. Kristina Kairaitis declares receiving honoraria for sleep education from SomnoMed.

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Subramanian, H., Trivedi, R., Fuchsova, V. et al. Follow-up assessment of sleep-related symptoms in patients after treatment for cancer: responses to continuous positive airway pressure treatment for co-morbid obstructive sleep apnoea. Sleep Breath 28, 725–733 (2024). https://doi.org/10.1007/s11325-023-02946-6

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