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From the Desk of the Editor - "The Impact our Therapies Have on Sleep"

Very often when a man is diagnosed with prostate cancer we consider how our therapies effect different aspects of their health and quality of life. However holistic we have become one area that we have not been as considerate about is the impact our therapies have on sleep and the subsequent impact sleep disturbance.

Thanks to Gonzalez et al. we now have data that suggest we need to look at this impact. Recently published in cancer the study compares objective and subjective sleep disturbance in patients with prostate cancer receiving androgen deprivation therapy (ADT) compared with patients with prostate cancer previously treated with surgery only as well as men without a cancer history. 

The study was set up with the hypothesized that ADT recipients would demonstrate worse sleep disturbance compared with controls. They also postulated that ADT would be associated with worse nocturia and hot flashes. Subjective sleep disturbance was assessed using the Insomnia Severity Index, a valid and reliable measure. This scale assesses the subjective difficulty respondents have in falling asleep and staying asleep. In addition, it looks at the impact sleep disturbance has on respondents daily functioning. Patient had objective assessment of sleep using a wrist worn actigraph.

The study results report that ADT recipients reported worse sleep disturbance, higher rates of clinically significant sleep disturbance, and greater hot flash interference than controls. ADT recipients had greater objective sleep disturbance and more episodes of nocturia. The association between ADT and objectively and subjectively measured sleep disturbance was partly attributable to nocturia and hot flashes. We understand that a prostate cancer therapy like ADT can have an effect on sleep because of nocturia, now we need to study treatment to mitigate this morbidity. 

Written by:  Benjamin M. Brucker, MD

References: 
Gonzalez BD, Small BJ, Cases MG, et al. Sleep disturbance in men receiving androgen deprivation therapy for prostate cancer: The role of hot flashes and nocturia.Cancer. 2018;124:499-506. doi: 10.1002/cncr.31024