Prospective analyses of cytokine mediation of sleep and survival in the context of advanced cancer

Jennifer L. Steel, Lauren Terhorst, Kevin P. Collins, David A. Geller, Yoram Vodovotz, Juliana Kim, Andrew Krane, Michael H Antoni, James W. Marsh, Lora E. Burke, Lisa H. Butterfield, Frank J. Penedo, Daniel J. Buysse, Allan Tsung

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective The aims of this study were to examine the potential association between sleep problems, symptom burden, and survival in patients with advanced cancer. Methods A prospective study of 294 patients with gastrointestinal cancer administered questionnaires assessing sleep, depression, anxiety, stress, pain, fatigue, and health-related quality of life. Serum levels of cytokines including interleukin (IL)-1α, IL-1β, tumor necrosis factor α, IL-10, IL-2, and interferon-γ were measured to assess biological mediation between sleep and survival. Survival was measured as time from diagnosis to death. Results Fifty-nine percent of patients reported poor sleep quality, 53% reported poor sleep efficiency, 39% reported sleep latency greater than 30 minutes, and 45% reported sleeping less than 6 hours or greater than 10 hours. We found a significant association between sleep duration and symptom burden. Shorter sleep duration was significantly associated with higher levels of fatigue (r = -0.169, p =.01), pain (r = -0.302, p =.01), anxiety (r = -0.182, p =.01), depression (r = -0.172, p =.003), and lower levels of quality of life (r = 0.240, p =.01). After adjustment for demographic, psychological, and disease-specific factors, short sleep duration was associated with reduced survival (hazard ratio [HR] linear = 0.485, 95% confidence interval = 0.275-0.857) and there was also evidence for a quadratic pattern (HR quadrati = 1.064, 95% confidence interval = 1.015-1.115) suggesting a curvilinear relationship between sleep duration and survival. Interleukin 2 was the only cytokine significantly related to survival (HR = 1.01, p =.003) and sleep duration (β = -30.11, p =.027). When of IL-2 was added to the multivariable model, short and long sleep (β = -0.557, p =.097; β = 0.046, p =.114) were no longer significantly related to survival, suggesting mediation by IL-2. Conclusion Sleep duration was associated with symptom burden and poorer survival and IL-2 was found to mediate the association between sleep and survival. Screening and treatment of sleep problems in patients diagnosed with cancer are warranted.

Original languageEnglish (US)
Pages (from-to)483-491
Number of pages9
JournalPsychosomatic Medicine
Volume80
Issue number5
DOIs
StatePublished - Jun 1 2018

Fingerprint

Sleep
Cytokines
Survival
Neoplasms
Interleukin-2
Interleukin-1
Fatigue
Anxiety
Quality of Life
Confidence Intervals
Depression
Pain
Gastrointestinal Neoplasms
Interleukin-10
Interferons
Tumor Necrosis Factor-alpha
Demography
Prospective Studies

Keywords

  • BMI = body mass index
  • Cancer
  • CRP = C-reactive protein
  • Cytokines
  • FACT-Hep = Functional Assessment of Cancer Therapy-Hepatobiliary
  • IL = interleukin
  • MinDC = minimum detectable concentration
  • Mortality
  • Sleep duration
  • Sleep problems
  • Sleep regulation

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

Cite this

Steel, J. L., Terhorst, L., Collins, K. P., Geller, D. A., Vodovotz, Y., Kim, J., ... Tsung, A. (2018). Prospective analyses of cytokine mediation of sleep and survival in the context of advanced cancer. Psychosomatic Medicine, 80(5), 483-491. https://doi.org/10.1097/PSY.0000000000000579

Prospective analyses of cytokine mediation of sleep and survival in the context of advanced cancer. / Steel, Jennifer L.; Terhorst, Lauren; Collins, Kevin P.; Geller, David A.; Vodovotz, Yoram; Kim, Juliana; Krane, Andrew; Antoni, Michael H; Marsh, James W.; Burke, Lora E.; Butterfield, Lisa H.; Penedo, Frank J.; Buysse, Daniel J.; Tsung, Allan.

In: Psychosomatic Medicine, Vol. 80, No. 5, 01.06.2018, p. 483-491.

Research output: Contribution to journalArticle

Steel, JL, Terhorst, L, Collins, KP, Geller, DA, Vodovotz, Y, Kim, J, Krane, A, Antoni, MH, Marsh, JW, Burke, LE, Butterfield, LH, Penedo, FJ, Buysse, DJ & Tsung, A 2018, 'Prospective analyses of cytokine mediation of sleep and survival in the context of advanced cancer', Psychosomatic Medicine, vol. 80, no. 5, pp. 483-491. https://doi.org/10.1097/PSY.0000000000000579
Steel, Jennifer L. ; Terhorst, Lauren ; Collins, Kevin P. ; Geller, David A. ; Vodovotz, Yoram ; Kim, Juliana ; Krane, Andrew ; Antoni, Michael H ; Marsh, James W. ; Burke, Lora E. ; Butterfield, Lisa H. ; Penedo, Frank J. ; Buysse, Daniel J. ; Tsung, Allan. / Prospective analyses of cytokine mediation of sleep and survival in the context of advanced cancer. In: Psychosomatic Medicine. 2018 ; Vol. 80, No. 5. pp. 483-491.
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abstract = "Objective The aims of this study were to examine the potential association between sleep problems, symptom burden, and survival in patients with advanced cancer. Methods A prospective study of 294 patients with gastrointestinal cancer administered questionnaires assessing sleep, depression, anxiety, stress, pain, fatigue, and health-related quality of life. Serum levels of cytokines including interleukin (IL)-1α, IL-1β, tumor necrosis factor α, IL-10, IL-2, and interferon-γ were measured to assess biological mediation between sleep and survival. Survival was measured as time from diagnosis to death. Results Fifty-nine percent of patients reported poor sleep quality, 53{\%} reported poor sleep efficiency, 39{\%} reported sleep latency greater than 30 minutes, and 45{\%} reported sleeping less than 6 hours or greater than 10 hours. We found a significant association between sleep duration and symptom burden. Shorter sleep duration was significantly associated with higher levels of fatigue (r = -0.169, p =.01), pain (r = -0.302, p =.01), anxiety (r = -0.182, p =.01), depression (r = -0.172, p =.003), and lower levels of quality of life (r = 0.240, p =.01). After adjustment for demographic, psychological, and disease-specific factors, short sleep duration was associated with reduced survival (hazard ratio [HR] linear = 0.485, 95{\%} confidence interval = 0.275-0.857) and there was also evidence for a quadratic pattern (HR quadrati = 1.064, 95{\%} confidence interval = 1.015-1.115) suggesting a curvilinear relationship between sleep duration and survival. Interleukin 2 was the only cytokine significantly related to survival (HR = 1.01, p =.003) and sleep duration (β = -30.11, p =.027). When of IL-2 was added to the multivariable model, short and long sleep (β = -0.557, p =.097; β = 0.046, p =.114) were no longer significantly related to survival, suggesting mediation by IL-2. Conclusion Sleep duration was associated with symptom burden and poorer survival and IL-2 was found to mediate the association between sleep and survival. Screening and treatment of sleep problems in patients diagnosed with cancer are warranted.",
keywords = "BMI = body mass index, Cancer, CRP = C-reactive protein, Cytokines, FACT-Hep = Functional Assessment of Cancer Therapy-Hepatobiliary, IL = interleukin, MinDC = minimum detectable concentration, Mortality, Sleep duration, Sleep problems, Sleep regulation",
author = "Steel, {Jennifer L.} and Lauren Terhorst and Collins, {Kevin P.} and Geller, {David A.} and Yoram Vodovotz and Juliana Kim and Andrew Krane and Antoni, {Michael H} and Marsh, {James W.} and Burke, {Lora E.} and Butterfield, {Lisa H.} and Penedo, {Frank J.} and Buysse, {Daniel J.} and Allan Tsung",
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T1 - Prospective analyses of cytokine mediation of sleep and survival in the context of advanced cancer

AU - Steel, Jennifer L.

AU - Terhorst, Lauren

AU - Collins, Kevin P.

AU - Geller, David A.

AU - Vodovotz, Yoram

AU - Kim, Juliana

AU - Krane, Andrew

AU - Antoni, Michael H

AU - Marsh, James W.

AU - Burke, Lora E.

AU - Butterfield, Lisa H.

AU - Penedo, Frank J.

AU - Buysse, Daniel J.

AU - Tsung, Allan

PY - 2018/6/1

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N2 - Objective The aims of this study were to examine the potential association between sleep problems, symptom burden, and survival in patients with advanced cancer. Methods A prospective study of 294 patients with gastrointestinal cancer administered questionnaires assessing sleep, depression, anxiety, stress, pain, fatigue, and health-related quality of life. Serum levels of cytokines including interleukin (IL)-1α, IL-1β, tumor necrosis factor α, IL-10, IL-2, and interferon-γ were measured to assess biological mediation between sleep and survival. Survival was measured as time from diagnosis to death. Results Fifty-nine percent of patients reported poor sleep quality, 53% reported poor sleep efficiency, 39% reported sleep latency greater than 30 minutes, and 45% reported sleeping less than 6 hours or greater than 10 hours. We found a significant association between sleep duration and symptom burden. Shorter sleep duration was significantly associated with higher levels of fatigue (r = -0.169, p =.01), pain (r = -0.302, p =.01), anxiety (r = -0.182, p =.01), depression (r = -0.172, p =.003), and lower levels of quality of life (r = 0.240, p =.01). After adjustment for demographic, psychological, and disease-specific factors, short sleep duration was associated with reduced survival (hazard ratio [HR] linear = 0.485, 95% confidence interval = 0.275-0.857) and there was also evidence for a quadratic pattern (HR quadrati = 1.064, 95% confidence interval = 1.015-1.115) suggesting a curvilinear relationship between sleep duration and survival. Interleukin 2 was the only cytokine significantly related to survival (HR = 1.01, p =.003) and sleep duration (β = -30.11, p =.027). When of IL-2 was added to the multivariable model, short and long sleep (β = -0.557, p =.097; β = 0.046, p =.114) were no longer significantly related to survival, suggesting mediation by IL-2. Conclusion Sleep duration was associated with symptom burden and poorer survival and IL-2 was found to mediate the association between sleep and survival. Screening and treatment of sleep problems in patients diagnosed with cancer are warranted.

AB - Objective The aims of this study were to examine the potential association between sleep problems, symptom burden, and survival in patients with advanced cancer. Methods A prospective study of 294 patients with gastrointestinal cancer administered questionnaires assessing sleep, depression, anxiety, stress, pain, fatigue, and health-related quality of life. Serum levels of cytokines including interleukin (IL)-1α, IL-1β, tumor necrosis factor α, IL-10, IL-2, and interferon-γ were measured to assess biological mediation between sleep and survival. Survival was measured as time from diagnosis to death. Results Fifty-nine percent of patients reported poor sleep quality, 53% reported poor sleep efficiency, 39% reported sleep latency greater than 30 minutes, and 45% reported sleeping less than 6 hours or greater than 10 hours. We found a significant association between sleep duration and symptom burden. Shorter sleep duration was significantly associated with higher levels of fatigue (r = -0.169, p =.01), pain (r = -0.302, p =.01), anxiety (r = -0.182, p =.01), depression (r = -0.172, p =.003), and lower levels of quality of life (r = 0.240, p =.01). After adjustment for demographic, psychological, and disease-specific factors, short sleep duration was associated with reduced survival (hazard ratio [HR] linear = 0.485, 95% confidence interval = 0.275-0.857) and there was also evidence for a quadratic pattern (HR quadrati = 1.064, 95% confidence interval = 1.015-1.115) suggesting a curvilinear relationship between sleep duration and survival. Interleukin 2 was the only cytokine significantly related to survival (HR = 1.01, p =.003) and sleep duration (β = -30.11, p =.027). When of IL-2 was added to the multivariable model, short and long sleep (β = -0.557, p =.097; β = 0.046, p =.114) were no longer significantly related to survival, suggesting mediation by IL-2. Conclusion Sleep duration was associated with symptom burden and poorer survival and IL-2 was found to mediate the association between sleep and survival. Screening and treatment of sleep problems in patients diagnosed with cancer are warranted.

KW - BMI = body mass index

KW - Cancer

KW - CRP = C-reactive protein

KW - Cytokines

KW - FACT-Hep = Functional Assessment of Cancer Therapy-Hepatobiliary

KW - IL = interleukin

KW - MinDC = minimum detectable concentration

KW - Mortality

KW - Sleep duration

KW - Sleep problems

KW - Sleep regulation

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