Primary Brain Tumor Patients Experience Significant Sleep Disturbance; An Analysis of Clinical Characteristics and Sleep Parameters
Zaid Soomro1, Kristin Alfaro2, Dave Balachandran2, Charles Bornstein1, Meliza Perez3, Juhee Song2, Garret Williford2, Ying Yuan2, John De Groot4, Alen Juginovic5
1Neuro-Oncology, MD Anderson Cancer Center, 2MD Anderson Cancer Center, 3Wellesley College, 4UT - MD Anderson Cancer Center, 5Harvard University
Objective:

To perform an analysis of clinical characteristics, and objective and subjective sleep parameters in adult primary brain tumor (PBT) patients experiencing sleep disturbance symptoms.

Background:

Patients with PBTs frequently report symptoms associated with sleep disturbances, which often remain undiagnosed. They contribute to disability and impaired quality of life (QoL). There is limited research in Neuro-Oncology incorporating clinical data and quantitative sleep parameters.

Design/Methods:

We conducted a single-institution retrospective chart review of patients > 18 years old with PBTs experiencing sleep disturbances referred to MD Anderson Cancer Center's Sleep Center.

We obtained patients' demographic and clinical data from medical records, whereas sleep data was obtained from Polysomnography, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and STOP-Bang questionnaire.

Results:

Most of the 31 patients had diffuse astrocytic and oligodendroglial tumors (69%) and tumor location in the cerebral cortex (71%). PBTs were of the following Grades: 1 (18.5%), 2 (29.6%), 3 (25.9%) and 4 (25.9%). 29% of patients experienced sleep disturbances before tumor diagnosis compared to 93.5% after treatment. Higher KPS was marginally associated with higher odds of normal sleep efficiency (p=0.07). More than 70% of patients had inadequate non-REM and REM duration. Latency to REM sleep was higher in diffuse astrocytic tumors than in other histologies. Tumor site other than the cerebral cortex was associated with apnea-hypopnea index ≥ 15. Central apneas were 49% more frequent than obstructive apneas. Patients with Grade 4 tumors had a higher STOP-Bang score compared to Grade 1.

Conclusions:

Most patients with PBTs experienced poor sleep quality, especially following tumor treatment. Tumor location and grade may influence sleep apnea severity. Central apneas occurred more often than obstructive apneas. Prospective studies should be pursued and include clinical data and quantitative sleep parameters in larger patient cohorts to elucidate the sleep-tumor connection, interventions to improve sleep and ultimately improve patient QoL.