Understanding the patient-experienced trajectory of sleep across the hematopoietic cell transplantation process

PURPOSE: Sleep disturbance is strongly associated with reduced quality of life and increased anxiety and depression. However, research on what contributes to these negative biobehavioral symptoms among hematopoietic cell transplantation (HCT) recipients remains limited. This study sought to understand sleep disturbances experienced by allogeneic HCT survivors from the perspectives of patients, clinicians, and caregivers, to identify key contributors to sleep disturbances across the HCT trajectory. METHODS: This cross-sectional qualitative study included semi-structured interviews with a purposive sample of HCT survivors, caregivers, and clinicians. Interview data were analyzed using an applied thematic approach. RESULTS: Participants (N = 29) were mostly female (69%), White (90%), and non-Hispanic (86%). Clinically relevant time periods emerged in patients' journeys that mark changes in their sleep patterns: during hospitalization, the isolation period after hospitalization, and at home after isolation (i.e., around day +90). In each period, cross-cutting themes emerged that present the trajectory of patients' sleep disturbance throughout the HCT process. Patients continued with poor maladaptive sleep habits acquired during hospitalization after returning home. CONCLUSION: This study expands research on biobehavioral symptoms among HCT recipients, providing context for quantitative findings in the literature and helping to map the sleep trajectory of allogeneic HCT recipients from multiple perspectives. Future research should consider using the patient, clinician, and caregiver perspectives presented in this work to identify points for targeted interventions that improve patients' sleep and overall quality of life and to advocate for "sleep-friendly" hospital procedures before chronic sleep issues become entrenched.