Longitudinal evaluation of sleep disturbances in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

PURPOSE: The current study examines longitudinal changes in sleep disturbances and the risks they pose for new-onset health conditions in survivors of childhood cancer. METHODS: Five-year survivors (N = 1081; median [range] age 50.0 [45.2-55.0] years) and siblings (N = 214; age 49.2 [39.9-51.1] years) from the Childhood Cancer Survivor Study completed the Pittsburgh Sleep Quality Index (PSQI) at two time points (median interval = 17 years). Sex-specific changes of PSQI scores were assessed, adjusting for demographics, using generalized estimating equation. Within survivors, logistic regressions estimated associations between persistent clinically significant sleep disturbances with diagnosis and treatment exposures, and new-onset chronic health conditions. RESULTS: Female siblings reported increases in sleep disturbances (T1 35% to T2 47%; PR = 1.30, 95% CI 1.04-1.62). However, increases among female survivors (T1 40% to T2 49%; PR = 1.25, 95% CI 0.99-1.58), male survivors (T1 34% to T2 44%; PR = 0.98, 95% CI 0.68-1.40), and male siblings (T1 24% to T2 32%; PR = 1.28, 95% CI 0.86-1.91) were not significant. Survivors reporting persistent sleep disturbances were more likely to develop new-onset hypertension (PR = 1.498, 95% CI 1.02-2.14), migraines (PR = 1.90, 95% CI 1.40-2.58), and emotional distress (PR = 8.07, 95% CI 4.07-16.00) but not subsequent malignancies (PR = 1.03, 95% CI 0.52-2.01). CONCLUSIONS: Persistent sleep disturbances are closely tied to the onset of chronic health conditions and mental health concerns. IMPLICATIONS FOR CANCER SURVIVORS: Screening for and treating sleep disturbances early in childhood cancer survivorship has the potential to improve long-term health and mental health.