Sleep disorder diagnosis prevalence among adult cancer patients.

Abstract

e24113 Background: Sleep is commonly impacted by cancer diagnosis and treatment. Poor sleep is consistently reported to be one of the most impactful sequelae of cancer on an individual’s quality-of-life, yet the prevalence of sleep disorders among cancer patients is not well understood. As a sleep disorder diagnosis is a critical first step in the treatment or referral pathway. We sought to examine the prevalence of sleep disorder diagnoses among cancer survivors at a comprehensive cancer center. Methods: We analyzed data from all adult cancer patients who presented for an outpatient visit at our center in 2024 (N = 107,080). Medical records were queried for patient demographics (age, sex, race, ethnicity, insurance status), disease department, and sleep disorder diagnoses based on ICD-10 codes. Diagnoses were grouped into 9 standard sleep disorder categories. Descriptive statistics and logistic regressions were used to calculate sleep disorder prevalence rates and odds ratios (OR) overall, and by various characteristics. Results: At our center, 1.72% of patients had at least one sleep disorder diagnosis. The most commonly diagnosed sleep disorders were insomnia (0.76%) and sleep disordered breathing (SDB, 0.64%). All other disorders were either unspecified or diagnosed at rates < 0.1%. Most patients (94.5%) were diagnosed with a single sleep disorder. Women were more likely to be diagnosed with sleep-related movement disorders (OR: 1.60, 95% CI: 1.03, 2.47) and less likely to be diagnosed with SDB (OR: 0.34, 95% CI: 0.29, 0.40) compared to men. Those who were younger (≤39 years) were less likely to be diagnosed with SDB (OR: 0.39, 95% CI: 0.26, 0.60) compared to those ≥65 years. Middle aged adults (40-64 years) were more likely to be diagnosed with insomnia (OR: 1.33, 95% CI: 1.15, 1.54) compared to those ≥65 years. Compared to White patients, Black patients were more likely to be diagnosed with SDB (OR: 1.47, 95% CI: 1.08, 2.01). Those with Medicare were more likely to be diagnosed with SDB (OR: 1.19, 95% CI: 1.01,1.41) compared to those with private insurance. Conclusions: Over 60% of cancer patients will report sleep issues at some point during treatment, with about 20% likely to meet diagnostic criteria for insomnia alone. In the context of our findings, it is likely that sleep disorders are underdiagnosed and not consistently billed for, leading to an underestimate of the true prevalence of the problem among cancer patients in a large academic and teaching hospital. This is a missed opportunity to provide patients with clinical attention for a medical problem that poses considerable risks to physical and psychological health. It is imperative that cancer centers develop a more consistent clinical care pathway to capture sleep disorders among patients during active treatment.