Short Sleep Duration and Physical and Psychological Health Outcomes
Among Adult Survivors of Childhood Cancer
Abstract
Background: To examine associations between phenotypes of short sleep
duration and clinically-assessed health conditions in long-term
survivors of childhood cancer. Methods: Survivors recruited from the St.
Jude Lifetime Cohort (n=911; 52% female; mean age 34 years; 26 years
post-diagnosis) completed behavioral health surveys and underwent
comprehensive physical examinations. Sleep was assessed with the
Pittsburgh Sleep Quality Index. Short sleep was defined as <7
hours per night with phenotypes of short sleep including poor sleep
efficiency (<85%), prolonged sleep onset latency (≥30
minutes), and wake after sleep onset (≥3 times per week). Covariates
included childhood cancer treatment exposures, demographics, body mass
index, and physical inactivity. Separate modified Poisson regression
models were computed for each health category to estimate relative risks
(RR) and 95% confidence intervals (CI). Multinomial logistic regression
models examined associations between sleep and an aggregated burden of
chronic health conditions. Results: Short sleep duration was reported
among 44% (95% CI 41%-47%) of survivors. In multivariable models,
short sleep duration alone was associated with pulmonary (RR=1.35, 95%
CI 1.08-1.69), endocrine (RR=1.22, 95% CI 1.06-1.39) and
gastrointestinal/hepatic conditions (RR=1.46, 95% CI 1.18-1.79), and
anxiety (RR 3.24, 95% CI 1.64-6.41) and depression (RR=2.33, 95% CI
1.27-4.27). Short sleep with prolonged SOL was associated with a
high/severe burden of health conditions (OR=2.35, 95% CI 1.12-4.94).
Conclusions: Short sleep duration was associated with multiple
clinically-ascertained adverse health conditions. Although the
temporality of these associations cannot be determined in this
cross-sectional study, sleep is modifiable, and improving sleep may
improve long-term health in survivors.