Yoga was developed >5,000 years ago as a comprehensive system of health and well-being for the mind, body, and soul. The word is believed to derive from the Sanskrit root "yuj" meaning to bind, yoke, union, and/or to concentrate one's attention. In health care, it often serves as a complementary mind-body practice, and it is increasingly being integrated into cancer care. It can be performed in the privacy of one's home through DVD or web-based programs or through group practices led by instructors who are often experienced working with students with medical issues. Most published evidence regarding yoga for seriously ill patients involves breast cancer survivors or breast cancer (stages I-IV) patients undergoing cancer treatment with a preserved functional capacity (ECOG <3). There is limited data examining its effectiveness or feasibility in children or for those with terminal cancer.
BACKGROUND: This study was conducted to determine the effect of lavender oil on sleep quality and vital signs in palliative care patients.
METHODS: We examined 68 patients in a palliative care unit. Vital signs of all the patients were assessed, and also their sleep quality was evaluated using the Richards-Campbell Sleep Questionnaire. Lavender was applied to patients in the experimental group. During the intervention, vital signs of the patients were monitored at 4-h intervals throughout the night, and sleep quality was evaluated during the morning. The same evaluation processes were performed for the control group.
RESULTS: It was observed in the evaluation that lavender application did not affect the vital signs of the patients but it ensured a deeper sleep on the 2nd day after the intervention, facilitated their falling asleep and sleeping again when they were awakened and enhanced sleep quality (p < 0.05). Also, this application decreased the awakening frequency on the 1st and 2nd days and enhanced overall sleep quality (p < 0.05) after the intervention.
CONCLUSIONS: Lavender has no effect on the vital signs of palliative care patients but is an effective and reliable approach to enhance their sleep quality.
Opioids are an effective treatment for patients with intractable pain. Long-term administration of opioids for pain relief is being delivered by an increasing number of medical providers in the United States including primary care physicians and nonspecialists. One common complication of chronic opioid use is sleep-disordered breathing which can result in various morbidities as well as an increase in all-cause mortality. It is important for providers to understand the relationship between opioids and sleep-disordered breathing as well as methods to improve diagnosis and strategies for treatment. This review aims to update clinicians on the mechanism, diagnosis, and treatment of opioid-related sleep-disordered breathing in order to improve the quality of care for patients with chronic pain.
OBJECTIVE: To evaluate sleep disturbances and to verify the accuracy of three screening tests to detect them in patients at the end-of-life admitted in a hospital palliative care unit.
METHOD: The level of sleep disturbances was evaluated through the Pittsburgh Sleep Quality Index (PSQI) in 150 palliative patients. This questionnaire was the criterion variable for testing the three screening tests used: Edmonton Symptom Assessment System (ESAS-Sleep subscale); the single question "How much do you worry about your sleep problems?" which is answered on a scale of 0-10 (Sleep-Worry-Q) and another single question: "Do you think you have sleep problems?" with two response categories, Yes/No (Sleep-Problem-Q).
RESULTS: According to the PSQI (cut-off point: 8), 87% of patients presented sleep disturbances. The ESAS-Sleep (cut-off point: 3) showed a sensitivity of 0.87, a specificity of 0.58, and an AUC of 0.729; the Sleep-Worry-Q (cut-off point: 4) showed a sensitivity of 0.95, a specificity of 0.68, and an AUC of 0.854; the Sleep-Problem-Q obtained a sensitivity of 0.92 and a specificity of 0.65.
SIGNIFICANCE OF RESULTS: Patients at the end-of-life, near the time of death, have high levels of sleep disturbances that can be detected early, with better diagnostic accuracy, with the Sleep-Worry-Q. Although from a clinical point of view, the application of the Sleep-Problem-Q may be more advantageous, as it presents good diagnostic accuracy, greater simplicity, and brevity.
Background: The literature describing the incidence of sleep difficulty in CNS cancers is very limited, with exploration of a sleep difficulty symptom trajectory particularly sparse in people with advanced disease. We aimed to establish the prevalence and longitudinal trajectory of sleep difficulty in populations with CNS cancers receiving palliative care nationally, and to identify clinically modifiable predictors of sleep difficulty.
Methods: A consecutive cohort of 2406 patients with CNS cancers receiving palliative care from sites participating in the Australian national Palliative Care Outcomes Collaboration were evaluated longitudinally on patient-reported sleep difficulty from point-of-care data collection, comorbid symptoms, and clinician-rated problems. Multilevel models were used to analyze patient-reported sleep difficulty.
Results: Reporting of mild to severe sleep difficulties ranged from 10% to 43%. Sleep scores fluctuated greatly over the course of palliative care. While improvement in patients' clinical status was associated with less sleep difficulty, the relationship was not clear when patients deteriorated. Worsening of sleep difficulty was associated with higher psychological distress (P < .0001), greater breathing problems (P < .05) and pain (P < .05), and higher functional status (P < .001) at the beginning of care.
Conclusions: Sleep difficulty is prevalent but fluctuates widely in patients with CNS cancers receiving palliative care. A better-tailored sleep symptom assessment may be needed for this patient population. Early interventions targeting psychological distress, breathing symptoms, and pain for more functional patients should be explored to see whether it reduces sleep difficulties late in life.
Background: Difficulty sleeping is a common symptom for patients living with cancer that significantly affects their lives. However, although sleep disorders are common, it is an overlooked problem in cancer care.
Purpose: This study assessed the prevalence of sleep disturbances among patients living with cancer, and assessed the adequacy of sleep assessment and intervention for patients from both nurses' and patients' perspectives.
Method: Descriptive, cross-sectional and correlational design was used in this study. A convenience sample of 129 patients with cancer and 113 registered nurses working with cancer patients was recruited. A structured face-to-face interview was used to complete the patients' questionnaires and a self-administered questionnaire was given to nurses.
Findings: The majority of patients with cancer reported having poor sleep quality (69.8%). About 86.7% (n=98) of nurses reported that they have never screened patients with cancer for any sleep problems, and 76.7% (n=99) of the patients reported that they have never been assessed for sleep problems by the nursing staff during hospitalisation. Only 8% of patients with cancer who reported having problems sleeping to a nurse received interventions to promote better sleep.
Conclusion: Assessment of sleep disturbances in patients with cancer should be unified using a comprehensive reliable valid instrument, as well as providing evidence-based interventions according to patient's need. A written policy should be introduced to encourage sleep documentation and to make sleep care for patients part of routine nursing care.
Objective/Background: About 15% of grievers experience complicated grief. We determined cross-sectional and longitudinal relations of grief and complicated grief with sleep duration and quality in the general population of elderly adults.
Participants: We included 5,421 men and women from the prospective population-based Rotterdam Study.
Methods: The Inventory of Complicated Grief was used to define grief and complicated grief. We assessed sleep with the Pittsburgh Sleep Quality Index.
Results: After 6 years, 3,511 (80% of survivors) underwent the follow-up interview. Complicated grief was cross-sectionally associated with shorter sleep duration and lower sleep quality. These associations were explained by the presence of depressive symptoms. The prospective analyses showed that sleep duration and sleep quality did not decline further during follow-up of persons who experienced grief or complicated grief.
Conclusion: In community-dwelling, middle-aged and older adults, persons with normal and complicated grief had both a shorter sleep duration and a lower sleep quality, mainly explained by depressive symptoms. However, prospective analyses showed that sleep quality and sleep duration do not decline further in persons with normal grief and complicated grief.
Introduction: Cancer-related drowsiness (CRD) is a distressing symptom in advanced cancer patients (ACP). The aim of this study was to determine the frequency and factors associated with severity of CRD. We also evaluated the screening performance of Edmonton Symptom Assessment Scale-drowsiness (ESAS-D) item against the Epworth Sedation Scale (ESS).
Method: We prospectively assessed 180 consecutive ACP at a tertiary cancer hospital. Patients were surveyed using ESAS, ESS, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Hospital Anxiety Depression Scale.
Result: Ninety of 150 evaluable patients had clinically significant CRD (ESS); median (interquartile ratio): ESS. 11 (7–14); ESAS-D. 5 (2–6); Pittsburgh Sleep Quality Index. 8 (5–11); Insomnia Severity Index. 13 (5–19); Stop Bang Scoring 3 (2–4), and Hospital Anxiety Depression Scale-D 6 (3–10). ESAS-D was associated with ESAS (r, p) sleep (0.38, <0.0001); pain (0.3, <0.0001); fatigue (0.51, <0.0001); depression (0.39, <0.0001); anxiety (0.44, <0.0001); shortness of breath (0.32, <0.0001); anorexia (0.36, <0.0001), feeling of well-being [(0.41, <0.0001), ESS (0.24, 0.001), and opioid daily dose (0.19, 0.01). Multivariate-analysis showed ESAS-D was associated with fatigue (odds ratio [OR] = 9.08, p < 0.0001), anxiety (3.0, p = 0.009); feeling of well-being (OR = 2.27, p = 0.04), and insomnia (OR = 2.35; p = 0.036). Insomnia (OR = 2.35; p = 0.036) cutoff score =3 (of 10) resulted in a sensitivity of 81% and 32% and specificity of 70% and 44% in the training and validation samples, respectively.
Significance of results: Clinically significant CRD is frequent and seen in 50% of ACP. CRD was associated with severity of insomnia, fatigue, anxiety, and worse feeling of well-being. An ESAS-D score of =3 is likely to identify most of the ACP with significant CRD.
BACKGROUND: Sleep disturbance is a significant issue, particularly for patients with advanced terminal illness. Currently, there are no practice-based recommended approaches for managing sleep and circadian disruptions in this population. To address this gap, a cross-sectional focus group study was performed engaging 32 staff members at four hospices/end-of-life programs in three demographically diverse counties in New York State.
METHODS: Participants responded to structured open-ended questions. Responses were transcribed and subjected to qualitative content analysis. The themes and recommendations for improved practice that emerged were tabulated using Atlas TI qualitative software.
RESULTS: This report details the experiences of hospice and end-of-life care staff in managing sleep and circadian disruptions affecting patients and analyzes their recommendations for improving care. Caregivers involved in the study described potential interventions that would improve sleep and reduce circadian disruptions. They particularly highlighted a need for improved evaluation and monitoring systems, as well as sleep education programs for both formal and informal caregivers.
CONCLUSIONS: The voiced experiences of frontline hospice and end-of-life caregivers confirmed that disruption in sleep and circadian rhythms is a common issue for their patients and is not effectively addressed in current research and practice. The caregivers' recommendations focused on management strategies and underscored the need for well-tested interventions to promote sleep in patients receiving end-of-life care. Additional research is needed to examine the effectiveness of systematic programs that can be easily integrated into the end-of-life care process to attenuate sleep disturbances.
OBJECTIVE: Spousal bereavement is linked to increased mortality and morbidity from inflammatory conditions. It also has a significant impact on sleep disturbances. Evidence from experimental studies indicates that chronic stress may prime individuals to have an exaggerated inflammatory response to acute stress. In this study, we examined the association between self-reported sleep disturbances and inflammation after adjusting for depressive symptoms, and determined whether this association varies by bereavement status (bereaved individuals vs. controls).
METHODS: Participants included 54 bereaved individuals and 47 controls with a mean age of 67.12 (SD=12.11). Inflammation was measured using C-reactive protein (CRP). Self-reported sleep disturbances were measured using the Pittsburgh Sleep Quality Index (PSQI). Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D).
RESULTS: Sleep disturbances were not associated with elevated levels of CRP in the overall group (B=0.030, standardized ß=0.122, 95% Confidence Intervals [CI]=-0.027 – 0.087, p=0.299) after adjusting for depressive symptoms. Results indicated, however, that bereavement moderated the association between inflammation and sleep disturbances (B=0.104, ß=0.517, 95% CI=0.009 – 0.198, p=0.032). Stratified analyses demonstrated that these associations differed across groups. Associations were significant among bereaved individuals (B=0.104, ß=0.406, 95% CI=0.013 – 0.196, p=0.026) and not controls (B=-0.016, ß=-0.066, 95% CI=-0.096 – 0.065, p=0.690).
CONCLUSIONS: These findings provide preliminary evidence that bereavement moderates the association between self-reported sleep disturbances and inflammation. Future studies should examine the course of sleep disturbances following bereavement and establish whether objective sleep has differential associations with inflammation among bereaved adults.
BACKGROUND: Pain in sickle cell disease (SCD) is often joined by other affective disorders such as depression and/or sleep impairment that can impact pain levels and quality of life (QoL).
AIM: To develop a guideline to improve the process of assessment and treatment of depression and sleep impairment in patients admitted with SCD.
METHOD: An interdisciplinary team used the Stetler model to create the Guideline for the Evaluation and Treatment of Depression and Sleep Impairment in Sickle Cell Disease. Patients were assessed, offered treatments and reassessed during the project period.
RESULTS: Both depression and QoL scores showed significant improvement by the end of the project. Significant correlations were found between pain, depression and sleep; depression, pain, sleep and QoL; sleep, pain and depression; and QoL and depression.
CONCLUSIONS: Interdisciplinary teams are effective in creating a guideline to assess and treat depression and sleep impairment and their effects on pain and QoL in patients with SCD.
OBJECTIVES: High rates of sleep difficulties have been found in patients with advanced cancer. However, not much is known about factors that are associated with sleep impairments in this population and that could constitute their potential risk factors or consequences. This study conducted in patients with cancer receiving palliative care aimed to evaluate the relationships of subjective (sleep diary; Insomnia Severity Index, ISI) and objective (actigraphy) sleep-wake variables with several physical and psychological symptoms, maladaptive sleep behaviours, erroneous beliefs about sleep, quality of life, time to death and environmental factors.
METHODS: The sample was composed of 57 community-dwelling patients with cancer receiving palliative care and with an Eastern Cooperative Oncology Group Scale score of 2 or 3. Actigraphic, light and sound recording and a daily sleep and pain diary were completed for seven consecutive days. A battery of self-report scales was also administered.
RESULTS: Greater disruptions of subjective and objective sleep-wake variables were more consistently associated with worse physical symptoms than with psychological variables. Disrupted objective sleep-wake parameters were also associated with a greater frequency of maladaptive sleep behaviours. Finally, a greater nocturnal noise in the bedroom was correlated with more impairments in subjective and objective sleep-wake variables while a lower 24-hour light exposure was associated with more disruption of subjectively assessed sleep only.
CONCLUSIONS: Although longitudinal studies are needed to establish the etiology of sleep-wake difficulties in patients with advanced cancer, our findings suggest that physical symptoms, maladaptive sleep behaviours and environmental factors can contribute to their development or their persistence and need to be adequately addressed.
BACKGROUND: High rates of sleep-wake difficulties have been found in patients with cancer receiving palliative care. Pharmacotherapy is the most frequently used treatment option to manage these difficulties despite numerous adverse effects and the absence of empirical evidence of its efficacy and innocuity in palliative care.
OBJECTIVE: This pilot study aimed to assess the feasibility and acceptability of a cognitive-behavioral and environmental intervention (CBT-E) to improve insomnia and hypersomnolence in patients with a poor functioning level and to collect preliminary data on its effects.
METHODS: Six patients with cancer receiving palliative care (Eastern Cooperative Oncology Group score 2-3), who had insomnia and/or hypersomnolence, received 1 CBT-E individual session at home. They applied the strategies for 3 weeks. Patients completed the Insomnia Severity Index, the Epworth Sleepiness Scale, a daily sleep diary, and a 24-hour actigraphic recording (7 days) at pretreatment and posttreatment, in addition to a semistructured interview (posttreatment).
RESULTS: Participants found strategies easy to apply most of the time, and none was rated as impossible to use because of their health condition. However, their adherence and satisfaction toward CBT-E were highly variable. Results on the effects of CBT-E were heterogeneous, but improvements were observed in patients with a persistent insomnia disorder.
CONCLUSIONS: The CBT-E protocol tested among this highly selected sample was fairly well received and suggested positive outcomes in some patients, particularly those with an insomnia complaint alone.
IMPLICATIONS: Efforts should be pursued to adapt CBT-E and develop other nonpharmacological interventions, in order to provide an alternative to pharmacotherapy for sleep-wake difficulties in this population.
OBJECTIVES: Patients receiving induction chemotherapy for acute myeloid leukaemia (AML) anecdotally describe poor sleep, but sleep disturbances have not been well-characterised in this population. We aimed to test the feasibility of measuring sleep quality in AML inpatients using a wearable actigraphy device.
METHODS: Using the Actigraph GT3X ‘watch’, we assessed the total sleep time, sleep onset latency, wake after sleep onset, number of awakenings after sleep onset and sleep efficiency for inpatients with AML receiving induction chemotherapy. We assessed patient self-reported sleep quality using the Pittsburgh Sleep Quality Index (PSQI).
RESULTS: Of the 12 patients enrolled, 11 completed all actigraphy and PSQI assessments, demonstrating feasibility. Patients wore the Actigraph device for a mean (SD) of 15.92 (8.3) days, and actigraphy measures suggested poor sleep. Patients had a median average awakening length of 6.92 min, a median number of awakenings after sleep onset of 4 and a median sleep onset latency of 10.8 min. Actual median sleep efficiency (0.91) was high, suggesting that patients’ poor sleep was not due to insomnia but perhaps due to interruptions, such as administration of medications, lab draws and vital sign measurements.
CONCLUSIONS: Collection of sleep quality data among inpatients with AML via a wearable actigraphy device is feasible. AML inpatients appear to have poor sleep quality and quantity, suggesting that sleep issues represent an area of unmet supportive care needs in AML. Further research in this areas is needed to inform the development of interventions to improve sleep duration and quality in hospitalised patients with AML.
Context: Data regarding health-related quality of life in breast cancer patients in the Middle East are limited with fatigue and sleep disturbance being the most distressing symptoms reported by patients treated for early breast cancer.
Aims: The aim of this study was to examine the prevalence and incidence of insomnia among patients with early-stage breast cancer patients treated with chemotherapy.
Subjects and Methods: This was a prospective cohort study. We enrolled patients with stage I-III breast cancer patients treated with chemotherapy at the American University of Beirut Medical Center. At three different time points (prior to, during, and following chemotherapy), we assessed the severity of sleep disturbances using the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. The Institution Review Board approved the study.
Results: Fifty-two patients were recruited. There was a significant increase in sleep disturbances during chemotherapy which improved to below baseline levels on completion of therapy. Prior to chemotherapy, 36% of patients reported poor sleep versus 58% during chemotherapy. The percentage of patients reporting clinical insomnia rose from 11% pretreatment to 36% during chemotherapy reflecting a significant symptomatic burden that is poorly documented and managed in routine clinical practice.
Conclusions: Patients with nonmetastatic breast cancer experience an increase in sleep disturbances during the treatment phase. Physicians should be aware of the need to routinely screen for sleep disturbance in breast cancer patients undergoing chemotherapy.
BACKGROUND: Sleep disturbance commonly has a negative impact on the well-being of family caregivers (FCs) of terminally ill patients with cancer. The effect of sleep disturbance on FCs has not been explored through long-term follow-up studies in Taiwan.
OBJECTIVE: The purposes of this study were to (1) identify the trajectory of sleep quality of FCs of terminally ill patients with cancer in Taiwan and (2) examine the determinants of sleep disturbance through a longitudinal follow-up until patient death.
METHODS: A prospective, longitudinal study was conducted among 95 FCs of terminally ill patients with cancer. The FCs' sleep quality was measured subjectively by using the Pittsburgh Sleep Quality Index and objectively by wearing a wrist actigraphy for 48 hours each month during the 6-month follow-up assessments. The trajectory and determinants of sleep quality were identified using a generalized estimation equation approach.
RESULTS: The FCs' sleep quality significantly decreased as the patient's death approached. Family caregivers who were women or older, had a relative with a longer survival period after diagnosis, reported higher levels of depression and fatigue, and provided lower levels of assistance to their relatives experienced more sleep disturbance.
CONCLUSION: The sleep quality of Taiwanese FCs significantly deteriorated as the death of the terminally ill patients with cancer approached. Early detection of the FCs' sleep disturbance, increasing their self-awareness of sleep problems, and providing nonpharmacological interventions and psychosocial support may be helpful for FCs to improve their quantity and quality of sleep.
Negative symptoms at the end of life are distressing for both the patient and family. Effective management of both physical and psychological symptoms improves quality of life and well-being, but intervention strategies are not always effective or feasible and often are exclusively pharmacologic. Developing treatment plans to meet symptom management needs is critical. A 2-site research study was conducted in southwest Ohio assessing effectiveness of Starlight Therapy in treating the negative symptoms associated with end of life. The study of 40 patients found the Starlight Therapy effective in treating the symptoms of anxiety, agitation, dyspnea, insomnia, and pain in 90% of the patients within a 30-minute period. The therapy was ineffective in only 4 patients. Physiological symptoms were measured upon initiating Starlight Therapy, 30 minutes after therapy, and 2 hours after therapy. Results found heart rate and respiratory rate significantly different from baseline to 30 minutes and from baseline to 2 hours (P < .05). Heart rate and respiratory rate were not significantly different from 30 minutes to 2 hours (P > .05). Further research is required to explore additional types of care, subjects, and sites, which could benefit from Starlight Therapy.
BACKGROUND: Sleep fragmentation is common among those with advanced serious illness. Nonpharmacological interventions to improve sleep have few, if any, adverse effects and are often underutilized in these settings.
OBJECTIVE: We aimed to summarize the literature related to nonpharmacological interventions to improve sleep among adults with advanced serious illness.
METHODS: We systematically searched six electronic databases for literature reporting sleep outcomes associated with nonpharmacological interventions that included participants with advanced serious illness during the period of 1996-2016.
RESULTS: From a total of 2731 results, 42 studies met the inclusion criteria. A total of 31 individual interventions were identified, each evaluated individually and some in combination with other interventions. Twelve of these studies employed either multiple interventions within an intervention category (n = 8) or a multicomponent intervention consisting of interventions from two or more categories (n = 5). The following intervention categories emerged: sleep hygiene (1), environmental (6), physical activity (4), complementary health practices (11), and mind–body practices (13). Of the 42 studies, 22 demonstrated a statistically significant, positive impact on sleep and represented each of the categories. The quality of the studies varied considerably, with 17 studies classified as strong, 17 as moderate, and 8 as weak.
CONCLUSIONS: Several interventions have been demonstrated to improve sleep in these patients. However, the small number of studies and wide variation of individual interventions within each category limit the generalizability of findings. Further studies are needed to assess interventions and determine effectiveness and acceptability.
BACKGROUND: Symptoms of terminal cancer have previously been reported as undertreated. The aim of this study was to assess the use of palliative medications before death from prostate cancer.
METHODS: This Swedish register study included men who died from 2009 to 2012 with prostate cancer as the underlying cause of death. We assessed the proportion who collected a prescription of androgen deprivation therapy, non-steroidal anti-inflammatory drugs, paracetamol, opioids, glucocorticoids, antidepressants, anxiolytics and sedative-hypnotics and the differences in treatment related to age, time since diagnosis, educational level, close relatives and comorbidities. Data were collected from 3 years before death from prostate cancer.
RESULTS: We included 8326 men. The proportion who received opioids increased from 30% to 72% during the last year of life, and 67% received a strong opioid at the time of death. Antidepressants increased from 13% to 22%, anxiolytics from 9% to 27% and sedative-hypnotics from 21% to 33%. Men without close relatives and older men had lower probability to receive opioids (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.47-0.66 for >85 years versus <70 years) and (OR 0.78, 95% CI: 0.66-0.92 for unmarried without children versus married with children).
CONCLUSION: Our results represent robust epidemiological data from Sweden for comparison of palliative care quality between countries. The findings indicate that men without close relatives and older men are disadvantaged with respect to the treatment of cancer pain and need closer attention from health care providers and highlight the importance to identify psychological distress in terminal prostate cancer.
CONTEXT: In advanced cancer, abnormal sleep patterns may contribute to poor quality of life but the impact of opioid related sleep disorders has not been explored in detail in these patients.
OBJECTIVE: To document sleep and respiratory patterns in patients with cancer, receiving a range of opioids, determine factors that contribute to severity of central or obstructive apnoea and to what extent these contribute to sleep disturbance.
METHODS: Adults with advanced cancer admitted to a palliative care service underwent a sleep analysis by an unattended polysomnograph. Total sleep time, apnea hypopnea index (AHI), central apnea index (CAI), obstructive apnoea hypopnea index OAHI), arousal index (AI) and oxygen desaturation were measured. Baseline assessment included body habitus, Mallampati score, comorbidity indices, concomitant medications and the Berlin questionnaire. Epworth sleepiness scale, Stanford Sleepiness scale and Wu cancer fatigue scales were documented RESULTS: 28 patients were studied, including 25 receiving opioids. In the latter group, the AHI was mildly abnormal in 6 patients and severely abnormal in 10 patients. CAI and OAHI were abnormal in 9 and 17 patients respectively. There was no significant correlation between opioid dose and polysomnographic results.
CONCLUSION: In patients with advanced cancer receiving opioid analgesia, there was a high prevalence of respiratory disturbance, both central and obstructive, and deranged sleep patterns. Addressing sleep disordered breathing in cancer patients has the potential to improve day-time drowsiness and quality of life.