Patient-Reported Sleep Quality at Baseline Correlates with 1-Year Survival after Allogeneic Hematopoietic Cell Transplantation in Adults

Background: While allogeneic hematopoietic cell transplantation (alloHCT) offers a potential cure to many patients with serious blood disorders, the process remains physically and psychologically arduous. Sleep dysfunction is nearly universal in the early post-HCT period and can lead to impaired quality of life, depression, fatigue and inflammation. Sleep dysfunction may adversely impact alloHCT outcomes through increased pro-inflammatory pathways as shown to be associated in other populations, and lead to adverse post-alloHCT outcomes. We hypothesized that patient-reported sleep dysfunction at baseline would correlate with post-alloHCT outcomes.

Material and Methods: From 2011 to 2013, the Center for International Blood and Marrow Transplant Research prospectively enrolled 390 patients from 7 transplant centers to assess the feasibility of collecting patient-reported outcomes. Patients completed the SF-36 and FACT-BMT surveys at pre-HCT, day 100, 6 months and 1 year. Sociodemographic information, disease- and transplant-specific data were routinely collected. In this study, we focus on responses to the sleep-specific question from FACT-BMT in a subset of adult patients (n=198) who underwent alloHCT for acute leukemia, myelodysplastic syndrome and myeloproliferative neoplasms. Descriptive statistics were used to summarize the patient sample and survival analysis was conducted using the Kaplan-Meier estimator. A significance level of 0.05 was used, and all tests are two-sided. The sleep question in FACT-BMT is a single validated question "I am sleeping well" with 5 answers (0- not at all, 1- a little bit, 2- somewhat, 3- quite a bit, 4- very much). We analyzed 0/1/2 as "poor sleep" and 3/4 as "good sleep" groups.

Results: Table 1 shows the baseline characteristics of the cohort. Patients aged <55 years, Karnofsky Performance Score (KPS) <90, and annual household income < $60,000 were more likely to have baseline poor sleep. Median follow-up of survivors was similar between the two groups and all survivors (N=131) had at least 12 months of follow up. The 1-year overall survival was 66 (59-73)%. Baseline "good sleep" in patients <55 years correlated with superior survival at 100 days, 6 months and 1 year compared to "poor sleep" <55 years (p<0.001) (Table 2). Baseline sleep did not correlate with survival in the ≥55 age group in unadjusted analysis (Figure).

Conclusions: Nearly 46% of adults undergoing alloHCT have self-reported poor sleep at pre-transplant baseline. Baseline sleep correlated with 1-year survival in patients under 55 years but not in those over 55 years of age. These intriguing results suggest further research to study potential etiologies of pre-transplant sleep dysfunction, especially in relation to pro-inflammatory pathways. Given the prevalence of sleep dysfunction, interventions to improve sleep should also be tested.

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