Sleep disorders and QOL in lung cancer survivors

描述（由研究者提供）：肺癌治疗的进展增加了长期（>5年）生存的机会。然而，这些肺癌幸存者，比大多数其他癌症幸存者，由于他们的肺癌治疗，过去的吸烟史和预先存在的疾病，有显着的额外的合并症。睡眠障碍，如失眠，尤其常见。初步调查显示，大多数肺癌幸存者患有失眠的比率高于大多数其他癌症的幸存者，即使在控制其他症状如呼吸困难时，这种失眠也与生活质量的显著损害有关，并且失眠患者的死亡率可能更高。本申请旨在通过在280名长期肺癌幸存者中进行一项研究来扩展这些发现，该研究在纵向设计中结合了多导睡眠图和肺功能测量，并进行了一年的随访重新评估;这是该患者人群的一种新方法。因此，拟议的研究是独特的设计，以测试的假设，睡眠障碍是常见的肺癌幸存者，并与显着的后遗症。它将解决几个关键的具体目标：1）使用多导睡眠图确定肺癌幸存者中睡眠障碍的患病率，这是唯一准确的方法来确定睡眠相关的呼吸障碍等; 2）确定失眠的危险因素; 3）确定失眠的纵向结果。除了探索肺癌幸存者的共病状况和睡眠障碍的相互作用外，这项拟议的研究还将研究睡眠-觉醒驱动中与年龄相关的变化的影响，例如褪黑激素水平的改变。从积极的心胸外科手术实践中获得大量幸存者群体以及研究团队的初步数据所证明的过去经验，增强了这种应用的整体可行性。该研究也有足够的把握来解决与癌症幸存者临床护理相关的几个特定假设。探索性分析包括与420名老年非癌症受试者的预先存在的数据集进行比较，以比较睡眠参数。该方案的一个重要发展方面是研究者将进行探索性多变量分析。这将用于为肺癌幸存者未来研究设计的样本量计算提供更准确的点估计，并确定未来干预研究的潜在领域。因此，这项研究的结果有可能大大提高我们对癌症幸存者睡眠障碍的病因和后果的理解，改善他们接受的临床护理，并为未来在这个相对研究不足的领域的研究奠定基础。 公共卫生相关性：失眠等睡眠障碍在肺癌幸存者中很常见，但在这方面的研究相对较少，过去的研究也没有包括诊断常见睡眠障碍的测试，如睡眠呼吸暂停（睡眠期间呼吸异常）。这项拟议中的研究将使用更准确的睡眠测试（也称为多导睡眠图），并随着时间的推移跟踪患者，以确定睡眠障碍是否会导致负面结果的风险增加。这些信息将有助于医生更好地了解和治疗癌症幸存者的睡眠问题。

DESCRIPTION (provided by investigator): Advances in lung cancer treatment have resulted in increased opportunities for long term (>5 year) survival. However, these lung cancer survivors, more so than most other cancer survivors, have significant additional comorbidity as a result of their lung cancer treatment, past smoking history and pre-existing diseases. Sleep disorders, such as insomnia, are especially common. Preliminary investigations have shown that the majority of these lung cancer survivors suffer from insomnia at rates higher than survivors of most other cancers, that this insomnia is associated with significant impairments in quality of life even when controlling for other symptoms such as dyspnea, and that mortality rates may be higher in those with insomnia. This application seeks to extend these findings by conducting a study in 280 long-term lung cancer survivors that incorporates polysomnography and pulmonary function measurements in a longitudinal design with a one-year follow-up reassessment; this is a novel approach in this patient population. The proposed study is thus uniquely designed to test the hypotheses that sleep disorders are common in lung cancer survivors and are associated with significant sequelae. It will address several key specific aims: 1) identify the prevalence of sleep disorders in lung cancer survivors using polysomnography, the only accurate method to identify sleep-related breathing disorders, amongst others; 2) determine the risk factors for insomnia; and 3) determine the longitudinal outcomes of insomnia. In addition to exploring the interaction of comorbid conditions and sleep disorders in lung cancer survivors, the proposed study will also examine the effects of age-related changes in the sleep-wake drive, such as altered melatonin levels. The overall feasibility of this application is enhanced by the access to a large survivor population from an active cardiothoracic surgery practice and the past experience of the research team as demonstrated by their preliminary data. The study is also adequately powered to address several specific hypotheses that are relevant to the clinical care of cancer survivors. Exploratory analyses include comparisons with a pre-existing dataset of 420 older non-cancer subjects to allow for comparison of sleep parameters. An important developmental aspect of the protocol is that the investigators will conduct exploratory multivariate analysis. This will be used to provide more accurate point estimates for sample size calculations for the design of future studies in lung cancer survivors and identify potential areas for future intervention studies. The findings from this study thus have the potential to significantly advance our understanding of the etiology and consequences of sleep disorders in cancer survivors, improve the clinical care they receive, and lay the groundwork for future investigations in this relatively understudied area. PUBLIC HEALTH RELEVANCE: Sleep disorders such as insomnia are common in lung cancer survivors, yet relatively little research has been done in this area and past studies have not included tests to diagnose common sleep disorders such as sleep apnea (abnormal breathing during sleep). The proposed study will use more accurate sleep tests (also known as polysomnographies) and follow patients over time to determine if sleep disorders can lead to increased risks of negative outcomes. This information will help physicians to better understand and treat sleep problems in cancer survivors.