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Excessive daytime sleepiness in cancer patients

  • Psychiatrics • Short Communication
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Excessive daytime sleepiness (EDS) is commonly reported in patients with cancer, and it is also a cardinal feature of central disorders of hypersomnolence. Multiple sleep latency testing (MSLT) is used for objective assessment.

Methods

A retrospective review of patients with cancer history who underwent formal sleep evaluation and MSLT from 2006 to 2019 was performed. Clinical characteristics, sleep-related history, and polysomnographic data were reviewed.

Results

Of 16 patients with cancer history, 9 were women (56%) and median age was 49. Cancer diagnoses included 4 central nervous system, 3 breast, 1 lymphoma, and 9 other solid malignancies, and 31% were undergoing active treatment. Comorbid conditions included depression, obstructive sleep apnea, and cancer-related fatigue. Daytime fatigue (94%), daily naps (81%), and EDS (69%) were the most common symptoms. Hypnopompic and hypnogogic hallucinations, sleep paralysis, sleep attacks, and cataplexy were present in a few. Epworth Sleepiness Scale scores were consistent with EDS in 88%, and mean sleep latency was less than 8 min in 69%. Only 31% had more than 2 sleep-onset REM periods. MSLT supported diagnoses of central disorders of hypersomnolence in 5 patients (4 narcolepsy, 1 idiopathic hypersomnia); 5 hypersomnia due to a medical disorder, psychiatric condition, or medication; and 6 with normal results. Pharmacotherapy was prescribed in 5 patients.

Conclusions

EDS in patients with cancer may be multifactorial, but persistent symptoms may indicate an underlying disorder of hypersomnolence. Sleep referral and polysomnography to exclude other sleep disorders may be indicated. MSLT can help confirm the diagnosis. In those with normal MSLT, further evaluation for mood disorder should be considered.

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Acknowledgments

We would like to thank the members of the sleep center (Leendert Keus, Ashley S. Knox, Stephen Mahoney, Gloria Oyekanmi, John N. Po) for their participation in the diagnostic study and clinical care of these patients.

Funding

This research is supported in part by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant (CA016672).

Author information

Authors and Affiliations

  1. Divisions of Pulmonary, Critical Care Medicine and Sleep Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA

    Bibi Aneesah Jaumally, Nathaniel C. Cassell & Ruckshanda Majid

  2. Division of Pulmonary, Critical Care and Sleep, The Ohio State University, Columbus, OH, USA

    Aneesa Das

  3. Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77030-1402, USA

    G. Nancy Pachecho, Lara Bashoura, Diwakar D. Balachandran & Saadia A. Faiz

Authors
  1. Bibi Aneesah Jaumally
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  2. Aneesa Das
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  3. Nathaniel C. Cassell
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  4. G. Nancy Pachecho
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  5. Ruckshanda Majid
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  6. Lara Bashoura
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  7. Diwakar D. Balachandran
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  8. Saadia A. Faiz
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Contributions

BJ and SF had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis and editing and writing of the manuscript; GP contributed substantially to study design, data collection, data analysis, and interpretation; AD, NC, RM, LB, and DB contributed substantially to data analysis and interpretation and editing of the manuscript.

Corresponding author

Correspondence to Saadia A. Faiz.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.

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Jaumally, B.A., Das, A., Cassell, N.C. et al. Excessive daytime sleepiness in cancer patients. Sleep Breath 25, 1063–1067 (2021). https://doi.org/10.1007/s11325-020-02151-9

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  • DOI: https://doi.org/10.1007/s11325-020-02151-9

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