LAUSR

Adult survivors of pediatric Hodgkin Lymphoma (HL) report poor sleep quality and excessive fatigue, often associated with obstructive sleep apnea (OSA). However, little is known about sleep dynamics in HL survivors without sleep disorders. In this exploratory study we evaluated quantitative and qualitative sleep of HL survivors without OSA and examined associations with cancer treatment and functional outcomes. Adult participants completed two consecutive nights of in-home polysomnography (PSG) with at least 4 hours of recorded sleep. For those participants with a sleep efficiency >85% and without OSA (HL survivors N=39, mean[SD] age=35[7.8] years; community controls N=33, age=29[7.4] years) PSG’s were scored following AASM guidelines. Standardized surveys assessed subjective sleep quality (PSQI), fatigue (FACIT-F) and quality-of-life (SF-36). Group differences were evaluated using ANCOVA adjusting for age. Multivariable linear regression was used to evaluate associations between sleep and SF36 measures. Kendall correlations were computed for objective and subjective sleep and chest radiation dosimetry. No significative differences between groups were found for standard objective PSG variables (sleep stages, latency, efficiency, etc.). Compared to controls, survivors had higher mean heart rate (HR) during sleep (p< 0.003), higher fatigue (p< 0.004), and lower sleep quality (p=0.005). Among HL survivors, poor PSQI ratings were associated with higher HR (τ = 0.36, p=0.001), lower sleep time (τ = -0.26, p=0.019) and increased fatigue (τ = -0.47, p< 0.001). Higher radiation dosimetry was associated with lower PSG sleep efficiency (τ = -0.23, p=0.042). Among survivors and community controls, mean HR during sleep (p=0.049) and lower sleep efficiency by PSG (p=0.032) were associated with poorer SF36 physical health (p< 0.001). HL Survivors demonstrate elevated mean HR during sleep, which is associated with patient reported functional limitations. Interventions to lower mean HR during sleep may have the potential to improve sleep quality, physical function, and overall quality of life. NCI - NCI NIH: 1R01CA215405, T32CA225590