Sleep duration is associated with survival in advanced cancer patients

Kevin P. Collins, David A. Geller, Michael Antoni, Drew Michael Donnell, Allan Tsung, James W. Marsh, Lora Burke, Frank Penedo, Lauren Terhorst, Thomas W. Kamarck, Anna Greene, Daniel J. Buysse, Jennifer L. Steel*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

78 Scopus citations


Objective Sleep problems have been linked to increased risk of mortality in the general population. Limited evidence suggests similar relationships among people diagnosed with cancer. The aims of the present study were to investigate the type and rates of sleep problems in advanced cancer patients and examine whether sleep problems are associated with survival. Methods A prospective study of 292 patients with advanced cancers affecting the hepatobiliary and pancreatic systems were administered a battery of questionnaires measuring sociodemographic information, sleep, and depression. Descriptive statistics, ANOVA, Chi-square, Kaplan–Meier survival, and Cox regression analyses were performed to test the aims. Results The majority of patients were male (64%) and the mean age was 62 years (SD = 11). Fifty-nine percent of patients reported poor sleep quality; 43% reported sleeping ≤6 h and 2% ≥10 h; 40% reported sleep latency of 30 min or greater; average sleep efficiency was 80%. Of the 292 patients, 58% reported clinically levels of depression and depressive symptoms were related to shorter sleep duration (p = 0.02). After adjusting for factors known to contribute to survival, a curvilinear relationship was observed between sleep duration and mortality: short and long sleep duration were associated with increased mortality [linear term: hazard ratio (HR) = 0.485, 95% confidence interval (CI) = 0.275–0.857; quadratic term: HR = 1.064, 95% CI = 1.015–1.115]. Conclusions Consistent with findings in the general population, a curvilinear relationship between sleep duration and mortality was observed in advanced cancer patients. The high prevalence of sleep problems and link with mortality warrants routine screening and development of evidence-based treatments for sleep problems in the oncology setting.

Original languageEnglish (US)
Pages (from-to)208-212
Number of pages5
JournalSleep Medicine
StatePublished - Apr 1 2017


  • Cancer
  • Hepatobiliary
  • PSQI
  • Sleep
  • Sleep duration
  • Survival

ASJC Scopus subject areas

  • General Medicine


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