Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Transplant Toxicities

Sleep quality following hematopoietic stem cell transplantation: longitudinal trajectories and biobehavioral correlates

Bone Marrow Transplantation volume 49, pages 1405–1411 (2014)Cite this article

Subjects

Abstract

The present study examined changes in sleep quality following hematopoietic stem cell transplantation (HSCT) and investigated associations with biobehavioral factors. Individuals undergoing HSCT for hematologic malignancies (N=228) completed measures of sleep quality and psychological symptoms pre-transplant and 1, 3, 6 and 12 months post transplant. Circulating inflammatory cytokines (IL-6, TNF-α) were also assessed. Sleep quality was poorest at 1 month post transplant, improving and remaining relatively stable after 3 months post transplant. However, approximately half of participants continued to experience significant sleep disturbance at 6 and 12 months post transplant. Mixed-effects linear regression models indicated that depression and anxiety were associated with poorer sleep quality, while psychological well-being was associated with better sleep. Higher circulating levels of IL-6 were also linked with poorer sleep. Subject-level fixed effects models demonstrated that among individual participants, changes in depression, anxiety and psychological well-being were associated with corresponding changes in sleep after covarying for the effects of time since transplant. Sleep disturbance was most severe when depression and anxiety were greatest and psychological well-being was lowest. Findings indicate that sleep disturbance is a persistent problem during the year following HSCT. Patients experiencing depression or anxiety and those with elevated inflammation may be at particular risk for poor sleep.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Pidala J, Anasetti C, Jim H . Quality of life after allogeneic hematopoietic cell transplantation. Blood 2009; 114: 7–19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Bush NE, Donaldson GW, Haberman MH, Dacanay R, Sullivan KM . Conditional and unconditional estimation of multidimensional quality of life after hematopoietic stem cell transplantation: a longitudinal follow-up of 415 patients. Biol Blood Marrow Transplant 2000; 6: 576–591.

    Article  CAS  PubMed  Google Scholar 

  3. Gruber U, Fegg M, Buchmann M, Kolb HJ, Hiddemann W . The long-term psychosocial effects of haematopoietic stem cell transplantation. Eur J Cancer Care (Engl) 2003; 12: 249–256.

    CAS  Google Scholar 

  4. Edman L, Larsen J, Hagglund H, Gardulf A . Health-related quality of life, symptom distress and sense of coherence in adult survivors of allogeneic stem-cell transplantation. Eur J Cancer Care (Engl) 2001; 10: 124–130.

    Article  CAS  Google Scholar 

  5. Boonstra L, Harden K, Jarvis S, Palmer S, Kavanaugh-Carveth P, Barnett J et al. Sleep disturbance in hospitalized recipients of stem cell transplantation. Clin J Oncol Nurs 2011; 15: 271–276.

    Article  PubMed  Google Scholar 

  6. Bush NE, Haberman M, Donaldson G, Sullivan KM . Quality of life of 125 adults surviving 6-18 years after bone marrow transplantation. Soc Sci Med 1995; 40: 479–490.

    Article  CAS  PubMed  Google Scholar 

  7. Andrykowski MA, Carpenter JS, Greiner CB, Altmaier EM, Burish TG, Antin JH et al. Energy level and sleep quality following bone marrow transplantation. Bone Marrow Transplant 1997; 20: 669–679.

    Article  CAS  PubMed  Google Scholar 

  8. Rischer J, Scherwath A, Zander AR, Koch U, Schulz-Kindermann F . Sleep disturbances and emotional distress in the acute course of hematopoietic stem cell transplantation. Bone Marrow Transplant 2009; 44: 121–128.

    Article  CAS  PubMed  Google Scholar 

  9. Andrykowski MA, Bishop MM, Hahn EA, Cella DF, Beaumont JL, Brady MJ et al. Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. J Clin Oncol 2005; 23: 599–608.

    Article  PubMed  Google Scholar 

  10. Illescas-Rico R, Amaya-Ayala F, Jimenez-Lopez JL, Caballero-Mendez ME, Gonzalez-Llaven J . Increased incidence of anxiety and depression during bone marrow transplantation. Arch Med Res 2002; 33: 144–147.

    Article  PubMed  Google Scholar 

  11. Syrjala KL, Chapko MK, Vitaliano PP, Cummings C, Sullivan KM . Recovery after allogeneic marrow transplantation: prospective study of predictors of long-term physical and psychosocial functioning. Bone Marrow Transplant 1993; 11: 319–327.

    CAS  PubMed  Google Scholar 

  12. Flynn KE, Shelby RA, Mitchell SA, Fawzy MR, Hardy NC, Husain AM et al. Sleep-wake functioning along the cancer continuum: focus group results from the Patient-Reported Outcomes Measurement Information System (PROMIS). Psychooncology 2009; 19: 1086–1093.

    Article  Google Scholar 

  13. Association AP. Diagnostic and statistical manual of mental disorders. Washington, DC 46: 2095–2098.

  14. Ohayon MM . Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002; 6: 97–111.

    Article  PubMed  Google Scholar 

  15. Mystakidou K, Parpa E, Tsilika E, Gennatas C, Galanos A, Vlahos L . How is sleep quality affected by the psychological and symptom distress of advanced cancer patients? Palliat Med 2009; 23: 46–53.

    Article  CAS  PubMed  Google Scholar 

  16. Bourdet C, Goldenberg F . Insomnia in anxiety: sleep EEG changes. J Psychosom Res 1994; 38 (Suppl 1): 93–104.

    Article  PubMed  Google Scholar 

  17. Spira AP, Friedman L, Aulakh JS, Lee T, Sheikh JI, Yesavage JA . Subclinical anxiety symptoms, sleep, and daytime dysfunction in older adults with primary insomnia. J Geriatr Psychiatry Neurol 2008; 21: 149–153.

    Article  PubMed  Google Scholar 

  18. Delgado-Guay M, Yennurajalingam S, Parsons H, Palmer JL, Bruera E . Association between self-reported sleep disturbance and other symptoms in patients with advanced cancer. J Pain Symptom Manage 2011; 41: 819–827.

    Article  PubMed  Google Scholar 

  19. Miller AH, Ancoli-Israel S, Bower JE, Capuron L, Irwin MR . Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol 2008; 26: 971–982.

    Article  CAS  PubMed  Google Scholar 

  20. Opp MR . Cytokines and sleep. Sleep Med Rev 2005; 9: 355–364.

    Article  PubMed  Google Scholar 

  21. Liu L, Mills PJ, Rissling M, Fiorentino L, Natarajan L, Dimsdale JE et al. Fatigue and sleep quality are associated with changes in inflammatory markers in breast cancer patients undergoing chemotherapy. Brain Behav Immun 2012; 26: 706–713.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sprod LK, Palesh OG, Janelsins MC, Peppone LJ, Heckler CE, Adams MJ et al. Exercise, sleep quality, and mediators of sleep in breast and prostate cancer patients receiving radiation therapy. Community Oncol 2010; 7: 463–471.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wang XS, Shi Q, Williams LA, Cleeland CS, Mobley GM, Reuben JM et al. Serum interleukin-6 predicts the development of multiple symptoms at nadir of allogeneic hematopoietic stem cell transplantation. Cancer 2008; 113: 2102–2109.

    Article  PubMed  Google Scholar 

  24. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ . The Pittsburgh Sleep Quality Index: A new instrument for psychiatric research and practice. Psychiatry Res 1989; 28: 193–213.

    Article  CAS  PubMed  Google Scholar 

  25. Carpenter JS, Andrykowski MA . Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res 1998; 45 (1 Spec No): 5–13.

    Article  CAS  PubMed  Google Scholar 

  26. Watson D, O'Hara MW, Simms LJ, Kotov R, Chmielewski M, McDade-Montez EA et al. Development and validation of the Inventory of Depression and Anxiety Symptoms (IDAS). Psychol Assess 2007; 19: 253–268.

    Article  PubMed  Google Scholar 

  27. McDade-Montez EA, Watson D . Examining the potential influence of diabetes on depression and anxiety symptoms via multiple sample confirmatory factor analysis. Ann Behav Med 2011; 42: 341–351.

    Article  PubMed  Google Scholar 

  28. Nylen KJ, Williamson JA, O'Hara MW, Watson D, Engeldinger J . Validity of somatic symptoms as indicators of depression in pregnancy. Arch Womens Ment Health 2013; 16: 203–210.

    Article  PubMed  Google Scholar 

  29. Collado-Hidalgo A, Bower JE, Ganz PA, Cole SW, Irwin MR . Inflammatory biomarkers for persistent fatigue in breast cancer survivors. Clin Cancer Res 2006; 12: 2759–2766.

    Article  CAS  PubMed  Google Scholar 

  30. Musselman DL, Miller AH, Porter MR, Manatunga A, Gao F, Penna S et al. Higher than normal plasma interleukin-6 concentrations in cancer patients with depression: preliminary findings. Am J Psychiatry 2001; 158: 1252–1257.

    Article  CAS  PubMed  Google Scholar 

  31. Meyers CA, Albitar M, Estey E . Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome. Cancer 2005; 104: 788–793.

    Article  CAS  PubMed  Google Scholar 

  32. Coe CL, Love GD, Karasawa M, Kawakami N, Kitayama S, Markus HR et al. Population differences in proinflammatory biology: Japanese have healthier profiles than Americans. Brain Behav Immun 2011; 25: 494–502.

    Article  CAS  PubMed  Google Scholar 

  33. Bevans MF, Mitchell SA, Marden S . The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT). Support Care Cancer 2008; 16: 1243–1254.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cohen MZ, Rozmus CL, Mendoza TR, Padhye NS, Neumann J, Gning I et al. Symptoms and quality of life in diverse patients undergoing hematopoietic stem cell transplantation. J Pain Symptom Manage 2012; 44: 168–180.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Syrjala KL, Langer S, Abrams J, Storer B, Martin P . Physical and mental recovery after hematopoietic stem cell transplantation. Discov Med 2004; 4: 263–269.

    PubMed  Google Scholar 

  36. Chao NJ, Tierney DK, Bloom JR, Long GD, Barr TA, Stallbaum BA et al. Dynamic assessment of quality of life after autologous bone marrow transplantation. Blood 1992; 80: 825–830.

    CAS  PubMed  Google Scholar 

  37. Peterson MJ, Benca RM . Sleep in mood disorders. Psychiatr Clin North Am 2006; 29: 1009–1032 abstract ix.

    Article  PubMed  Google Scholar 

  38. Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 2011; 135: 10–19.

    Article  PubMed  Google Scholar 

  39. Vgontzas AN, Fernandez-Mendoza J . Insomnia with short sleep duration: nosological, diagnostic, and treatment implications. Sleep Med Clin 2013; 8: 309–322.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Laugsand LE, Strand LB, Platou C, Vatten LJ, Janszky I . Insomnia and the risk of incident heart failure: a population study. Eur Heart J 2013; 35: 1382–1393.

    Article  PubMed  Google Scholar 

  41. Jaffer U, Wade RG, Gourlay T . Cytokines in the systemic inflammatory response syndrome: a review. HSR Proc Intensive Care Cardiovasc Anesth 2010; 2: 161–175.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Slavich GM, Way BM, Eisenberger NI, Taylor SE . Neural sensitivity to social rejection is associated with inflammatory responses to social stress. Proc Natl Acad Sci USA 2010; 107: 14817–14822.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. National Comprehensive Cancer N. Distress management. Clinical practice guidelines. J Natl Compr Canc Netw 2003; 1: 344–374.

    Article  Google Scholar 

  44. Espie CA, Fleming L, Cassidy J, Samuel L, Taylor LM, White CA et al. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. J Clin Oncol 2008; 26: 4651–4658.

    Article  PubMed  Google Scholar 

  45. Neikrug AB, Rissling M, Trofimenko V, Liu L, Natarajan L, Lawton S et al. Bright light therapy protects women from circadian rhythm desynchronization during chemotherapy for breast cancer. Behav Sleep Med 2012; 10: 202–216.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by Grants R21 CA133343 and K07 CA136966 from the National Cancer Institute to ESC, KL2 RR0205012 from the National Center for Research Resources, P30 CA014520 from the UWCCC, and an award from the Forward Lymphoma Foundation.

Author information

Authors and Affiliations

  1. Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA,

    A M Nelson

  2. Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA,

    C L Coe

  3. Hematology/Oncology Division, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA,

    M B Juckett & P Hematti

  4. Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA,

    M B Juckett, P Hematti & E S Costanzo

  5. Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA,

    M E Rumble & E S Costanzo

  6. Center for Sleep Medicine and Research, University of Wisconsin-Madison, Madison, WI, USA

    M E Rumble

  7. Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA

    P J Rathouz

Authors
  1. A M Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C L Coe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M B Juckett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M E Rumble
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P J Rathouz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P Hematti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E S Costanzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E S Costanzo.

Ethics declarations

Competing interests

The authors declare no conflicts of intrest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nelson, A., Coe, C., Juckett, M. et al. Sleep quality following hematopoietic stem cell transplantation: longitudinal trajectories and biobehavioral correlates. Bone Marrow Transplant 49, 1405–1411 (2014). https://doi.org/10.1038/bmt.2014.179

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2014.179

This article is cited by

Search

Advanced search

Quick links