Circadian activity rhythms and fatigue of adolescent cancer survivors and healthy controls: a pilot study

Valerie E Rogers; Catriona Mowbray; Shijun Zhu; Lianqi Liu; Sonia Ancoli-Israel; Erik A Barr; Pamela S Hinds

doi:10.5664/jcsm.8458

Circadian activity rhythms and fatigue of adolescent cancer survivors and healthy controls: a pilot study

J Clin Sleep Med. 2020 Jul 15;16(7):1141-1147. doi: 10.5664/jcsm.8458.

Authors

Valerie E Rogers^{1

2}, Catriona Mowbray³, Shijun Zhu¹, Lianqi Liu⁴, Sonia Ancoli-Israel⁴, Erik A Barr¹, Pamela S Hinds^{3

5}

Affiliations

¹ University of Maryland, Baltimore, Maryland.
² Retired.
³ Children's National Health System, Washington, DC.
⁴ University of California, San Diego, California.
⁵ George Washington University, Washington, DC.

Abstract

Study objectives: The primary objective of this study was to compare circadian activity rhythms (CARs) of adolescents within 5 years of completing cancer treatment (survivors) with that of healthy adolescent controls. Secondary objectives were to explore differences in the relationship of CARs and fatigue between survivors and controls and between early survivors (<12 months posttreatment) and late survivors (≥12 months posttreatment).

Methods: Twenty-nine survivors and 30 controls, aged 13-18 years, participated in this prospective, descriptive pilot study. Adolescents and their parents completed a baseline measure of adolescents' fatigue. Adolescents wore a wrist actigraph continuously for 7 days and concurrently kept a sleep diary. Activity data recorded by actigraphy were fitted to an extended cosine model to calculate six CAR variables: acrophase, amplitude, midline estimating statistic of rhythm (MESOR), up-MESOR, down-MESOR, and F-statistic. Linear mixed models explored the relationship between CARs and fatigue.

Results: There were no group differences on CAR or fatigue measures. Among survivors, earlier down-MESOR was associated with greater parent-reported fatigue (P = .020), and earlier acrophase (P = .023) and up-MESOR (P = .025) were associated with greater adolescent-reported fatigue. Significant CAR-by-time posttreatment interaction effects were found on fatigue between early and late survivors. Among controls, greater parent-reported fatigue was associated with greater MESOR (P = .0495).

Conclusions: Survivors within the first 5 years posttreatment were similar to controls in CARs and fatigue, suggesting robust recovery of circadian rhythms posttreatment. Different CAR characteristics were associated with fatigue in survivors and controls. Time posttreatment influenced the relationship between CARs and fatigue for survivors, with significant effects only for early survivors.

Keywords: actigraphy; adolescents; cancer survivorship; circadian activity rhythms; fatigue.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Actigraphy
Adolescent
Cancer Survivors*
Circadian Rhythm
Fatigue
Humans
Neoplasms*
Pilot Projects
Prospective Studies
Sleep