Tele-Monitoring of Cancer Patients' Rhythms during Daily Life Identifies Actionable Determinants of Circadian and Sleep Disruption
Tele-Monitoring of Cancer Patients' Rhythms during Daily Life Identifies Actionable Determinants of Circadian and Sleep Disruption
复制标题
DOI：
10.3390/cancers12071938
复制
发表时间：
2020-07-01
期刊：
影响因子：
5.2
通讯作者：
Innominato, Pasquale
中科院分区：
文献类型：
--
作者：
Levi, Francis;Komarzynski, Sandra;Innominato, Pasquale
二分法指数(I<；O)是对白天活动和睡眠的昼夜节律的定量估计，它预测了总体癌症存活率和紧急住院时间，支持其与mHealth平台的集成。在25名胃肠癌患者和33名年龄和性别分层的对照组中，寻找了I<；O恶化低于97.5%的可修改原因-(I<；O)(低)。休息-活动和体温通过无线胸部传感器进行远程监测，而日常活动、饮食和睡眠则自我报告一周。测定唾液皮质醇节律和暗光褪黑素发作(DLMO)。昼夜节律参数的估计使用隐马尔可夫模型和频谱分析。通过相关和回归分析确定(I<；O)(LOW)的可行预测因子。遵守方案的中位数超过95%。在13名(52%)患者和4名(12%)对照组中发现了昼夜节律紊乱-(I<；O)(低)(p=0.002)。与I<；O超过97.5%-(I<；O)(高)-(p<；0.012)的癌症患者相比，(I<；O)(低)癌症患者的活动计数中位数更低，睡眠更零碎，昼夜节律异常或没有昼夜节律。6名(I<；O)(低)患者有新诊断的睡眠状况。静息-活动和胸部表面温度的昼夜节律协调改变、身体活动不足和睡眠不规律被确定为(I<；O)(LOW)的可改变的决定因素。昼夜节律和睡眠远程监测结果支持具体干预措施的设计，以改善以患者为中心的系统卫生保健方法的结果。
The dichotomy index (I < O), a quantitative estimate of the circadian regulation of daytime activity and sleep, predicted overall cancer survival and emergency hospitalization, supporting its integration in a mHealth platform. Modifiable causes of I < O deterioration below 97.5%-(I < O)(low)-were sought in 25 gastrointestinal cancer patients and 33 age- and sex-stratified controls. Rest-activity and temperature were tele-monitored with a wireless chest sensor, while daily activities, meals, and sleep were self-reported for one week. Salivary cortisol rhythm and dim light melatonin onset (DLMO) were determined. Circadian parameters were estimated using Hidden Markov modelling, and spectral analysis. Actionable predictors of (I < O)(low)were identified through correlation and regression analyses. Median compliance with protocol exceeded 95%. Circadian disruption-(I < O)(low)-was identified in 13 (52%) patients and four (12%) controls (p= 0.002). Cancer patients with (I < O)(low)had lower median activity counts, worse fragmented sleep, and an abnormal or no circadian temperature rhythm compared to patients with I < O exceeding 97.5%-(I < O)(high)-(p< 0.012). Six (I < O)(low)patients had newly-diagnosed sleep conditions. Altered circadian coordination of rest-activity and chest surface temperature, physical inactivity, and irregular sleep were identified as modifiable determinants of (I < O)(low). Circadian rhythm and sleep tele-monitoring results support the design of specific interventions to improve outcomes within a patient-centered systems approach to health care.