Author(s)
Ayush G. Iyer, BS
Rebecca Lee, MD
Rebecca Eary, MD
Justin R. Shinn, MD
Jordan R. Salley, MD
Erika Ren, BS
Dalia N. Mitchell, MSCI
Sanjana Balachandra, MD
Teena Sura, MPH
Yulun Liu, PhD
Eric S. Zhou, PhD
Andrew T. Day, MD MPH
Affiliation(s)
UT Southwestern Medical Center
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the epidemiology and significance of insomnia symptoms in head and neck cancer (HNC) survivors.
Objectives: To characterize the prevalence, risk factors, and nature of insomnia symptoms in HNC survivors relative to survivors of other cancers (SOCs) and non-cancer controls (NCCs).
Study Design: Cross-sectional analysis of the National Health Interview Survey.
Methods: HNC survivors were matched by age, sex, race/ethnicity, and survey year to SOCs and NCCs at a 1:4:4 ratio from 2013-2018. The study was framed using Grandner et al.’s socio-ecological model for sleep health. The primary outcome was insomnia symptoms, based on DSM V diagnostic criteria for insomnia disorder. The co-primary exposures were pain of the head, neck, or face as well as severe psychological distress. Weighted descriptive statistics and multivariable logistic regression were performed using STATA 18.
Results: Using weighted data, 157,240 HNC survivors, 671,909 matched SOCs, and 659,968 matched NCCs with sleep data were identified. Compared to SOCs, HNC survivors were disproportionately less educated and more economically disadvantaged. HNC survivors had a similar prevalence rate of insomnia symptoms compared to SOCs (HNC=29.2%;SOC=25.1%;p=0.213) and a significantly higher rate compared to NCCs (NCC=20.3%;p=0.005). Still, relative to SOCs and NCCs, HNC survivors experienced significantly higher rates of sleep medication use (HNC=25.7%;SOC=18.9%;NCC=17.9%) and difficulty maintaining sleep (HNC=41.9%;SOC=34.0%;NCC=30.3%). On adjusted weighted analyses evaluating risk factors for insomnia symptoms in HNC survivors, younger age (aOR=0.96;p=0.035), head, neck, or face pain (aOR=3.49;p=0.005), sleeping <7 hours per night (aOR=3.49;p=0.004), and lower back or joint pain (aOR=3.28;p=0.021) significantly associated with the outcome.
Conclusions: These data underscore the importance of screening for and managing both insomnia and pain in HNC survivors.