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Rest/activity rhythm is related to the coexistence of pain and sleep disturbance among advanced cancer patients with pain

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Abstract

Purpose

This study aimed to explore the relationships among pain, sleep disturbance, and circadian rhythms in advanced cancer patients.

Methods

This cross-sectional study was conducted in 68 cancer patients from the oncology inpatient unit of a teaching hospital. Their demographic and medical characteristics, questionnaire surveys, including Brief Pain Inventory-Chinese version and Pittsburgh Sleep Quality Index Taiwanese version, and sleep logs and actigraphic recordings in consecutive 3 days and nights were collected and analyzed.

Results

The mean (SD) scores for autocorrelation coefficient at 24 h (r24) and dichotomy index (I<O) were 0.19 (0.16) and 85.29 % (0.13 %), respectively, indicating dampened circadian rhythms in participants. The mean (SD) worst pain score was 5.47 (2.70). The sleep quality global score ranged 4 ∼ 19 with a mean (SD) of 11.19 (4.05). The worst pain levels, the Pittsburgh Sleep Quality Index (PSQI) global score, and most sleep parameters measured by actigraphy were significantly correlated with r24 and I<O. The worst pain score was significantly correlated with the PSQI global score (r = 0.69, p < 0.01). The Goodman version of the Sobel test further demonstrated that 45.77 % of the total effect was mediated by pain intensity (t = 2.76, p = 0.005). Pain was a complete mediator between circadian rhythms and sleep quality.

Conclusions

The rest/activity rhythm influences the coexisting pain and sleep disturbances. Pain functions as a complete mediator in their relationship. Interventions that improve rest/activity rhythms may improve the management of pain and sleep disturbances in cancer patients.

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Acknowledgments

This study was supported by the Tungs’ Taichung MetroHarbor Hospital (TTM-TMU-96-05). The authors would like to thank Ms. Denise Dipert for her careful review and expertise editing this manuscript.

Conflict of interest

The authors have no conflicts of interest or financial relationships to disclose.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan

    Chen-Lai Ma

  2. Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan

    Wen-Pei Chang

  3. School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan

    Chia-Chin Lin

  4. Ministry of Health and Welfare, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan

    Wen-Pei Chang

Authors
  1. Chen-Lai Ma
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  2. Wen-Pei Chang
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Corresponding author

Correspondence to Chia-Chin Lin.

Additional information

Chen-Lai Ma and Wen-Pei Chang contributed equally to this study.

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Ma, CL., Chang, WP. & Lin, CC. Rest/activity rhythm is related to the coexistence of pain and sleep disturbance among advanced cancer patients with pain. Support Care Cancer 22, 87–94 (2014). https://doi.org/10.1007/s00520-013-1918-0

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  • DOI: https://doi.org/10.1007/s00520-013-1918-0

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