Sleep quality trajectories from head and neck cancer diagnosis to six months after treatment

Oral Oncol. 2021 Apr:115:105211. doi: 10.1016/j.oraloncology.2021.105211. Epub 2021 Feb 12.


Objectives: Patients with head and neck cancer (HNC) often report disturbances in their sleep quality, impairing their quality of life. This study aims to examine the trajectories of sleep quality from diagnosis up to 6-month after treatment, as well as the pre-treatment risk factors for poor sleep trajectories.

Materials and methods: Sleep quality (Pittsburgh sleep quality index) was measured shortly after diagnosis (pre-treatment), and at 3 and 6 months after finishing treatment. Patients were categorized into 5 trajectory groups. We examined the association of sleep quality trajectories with sociodemographic and clinical characteristics, coping style, HNC symptoms, and psychological distress.

Results: Among 412 included patients, about a half either had a persistent good sleep (37.6%) or an improving (16.5%) trajectory. About a third had a persistent poor sleep (21.8%) or worsening (10.9%) sleep trajectory. The remaining patients (13.1%), alternated between good and poor sleep. Using persistent good sleep as a reference outcome, persistent poor sleepers were more likely to be woman (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.01-3.90), use painkillers prior to treatment (OR = 2.52, 95% CI 1.33-4.77), and have more pre-treatment anxiety symptoms (OR = 1.26, 95% CI 1.15-1.38).

Conclusion: Unfavorable sleep quality trajectories are prevalent among HNC patients from pre-treatment to 6-month after treatment. A periodic sleep evaluation starting shortly after HNC diagnosis is necessary to identify persistent sleep problems, especially among high-risk group.

Keywords: Head and neck cancer; Sleep quality; Trajectory; Treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Head and Neck Neoplasms / complications*
  • Head and Neck Neoplasms / pathology
  • Humans
  • Male
  • Middle Aged
  • Quality of Life
  • Sleep / physiology*
  • Sleep Wake Disorders / etiology*
  • Time Factors