1024 Longitudinal Evaluation of Sleep Disturbances in Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study (CCSS)

Abstract Introduction Surviving childhood cancer and aging are both risk factors for poor sleep. The current study examines longitudinal changes in sleep in childhood cancer survivors relative to siblings and the risks that persistent sleep disturbances pose for new onset health conditions. Methods Five-year survivors (N=1,081; 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 timepoints (median interval=17 years, range 15-18 years). Changes in PSQI scores over time were assessed, stratified by sex and adjusting for demographics, using generalized estimating equation. Within survivors, logistic regressions estimated associations between persistent clinically significant sleep disturbances (PSQI total score >5 at both time points) with diagnosis and treatment exposures, and new onset chronic health conditions. Results Female siblings reported increases in sleep disturbances (Change from a prevalence of 35% at T1 to 47% at T2; 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) did not achieve statistical significance. Male survivors were more likely to report sleep disturbances compared to male siblings at T2 (p=.034), but differences between female survivors and siblings were not significant (p=.709). Survivors reporting persistent sleep disturbances were more likely to develop new onset hypertension (PR=1.46, 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). Conclusion Persistent sleep disturbances are associated with increased risk for new onset of chronic physical health conditions and emotional distress. Screening for and treating sleep disturbances early in the trajectory of childhood cancer survivorship should be evaluated for prevention of new onset of chronic health conditions. Support (if any) This work was supported by the National Cancer Institute (CA55727, G.T. Armstrong, Principal Investigator). Support to St. Jude Children’s Research Hospital also provided by the Cancer Center Support (CORE) grant (CA21765, C. Roberts, Principal Investigator) and the American Lebanese-Syrian Associated Charities (ALSAC).