Sleep disorders and QOL in lung cancer survivors

描述(由研究人员提供)：肺癌治疗的进步增加了长期(5年)生存的机会。然而，与大多数其他癌症幸存者相比，这些肺癌幸存者由于肺癌治疗、既往吸烟史和既往疾病而有显著的额外合并症。失眠等睡眠障碍尤其常见。初步调查显示，这些肺癌幸存者中的大多数人患失眠症的比例高于大多数其他癌症的幸存者，即使在控制了呼吸困难等其他症状的情况下，这种失眠也与生活质量的严重损害有关，而且失眠者的死亡率可能更高。这项应用旨在通过对280名长期肺癌幸存者进行研究来扩展这些发现，该研究将多导睡眠图和肺功能测量纳入纵向设计，并进行一年的随访重新评估；这是一种在这一患者群体中使用的新方法。因此，这项拟议的研究被独特地设计来检验这样的假设，即睡眠障碍在肺癌幸存者中很常见，并与重大后遗症有关。它将解决几个关键的具体目标：1)使用多导睡眠图来确定肺癌幸存者中睡眠障碍的患病率，这是识别与睡眠相关的呼吸障碍的唯一准确方法；2)确定失眠的风险因素；以及3)确定失眠的纵向结果。除了探索肺癌幸存者的共病条件和睡眠障碍的相互作用外，这项拟议的研究还将研究与年龄相关的睡眠-觉醒驱动变化的影响，如褪黑素水平的变化。从积极的心胸外科实践中获得大量幸存者，以及研究团队的初步数据表明，他们过去的经验证明了这一应用的总体可行性。这项研究也充分说明了与癌症幸存者的临床护理相关的几个具体假设。探索性分析包括与先前存在的420名老年非癌症受试者的数据集进行比较，以允许比较睡眠参数。该方案的一个重要发展方面是，调查人员将进行探索性多变量分析。这将被用来为设计未来肺癌幸存者研究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区域。因此，这项研究的发现有可能显著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，并为这一相对研究较少的领域的未来研究奠定基础。 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睡眠呼吸暂停(睡眠期间呼吸异常)等常见睡眠障碍的测试。这项拟议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风险增加。这些信息将帮助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.