NSO-04: Characterising sleep disturbances with actigraphy in those receiving steroids for the treatment of multiple myeloma: Findings from a pilot study

Introduction: Glucocorticosteroids (steroids), central to the treatment of multiple myeloma (MM), have multiple deleterious side effects (SE). Our team found that disturbed sleep was the most frequently reported SE, identified in up to 95% of patients (King et al 2019), with 67% of patients reporting severe sleep disturbances. This pilot study, funded by a grant from Sydney Blood Cancer Institute, is the first to characterise sleep disturbances associated with steroid treatment in MM using objective measures of sleep quality.

Methods: 10 MM participants currently taking steroids for MM, with associated disturbed sleep and an ECOG ≤ 2 were recruited. Participants were assessed for risk of obstructive sleep apnoea (OSA), and those found to be at high risk of OSA excluded from the study. Sleep duration, sleep efficiency and wake bouts were measured over the three weeks of monitoring using actigraphy, a validated method of objective long-term sleep monitoring using a watch-like device, and sleep diaries to document subjective sleep experience. Actigraphy data was analysed in a blinded fashion, utilising light, and activity levels to determine attempted sleep periods, with sleep diaries to confirm these. Semi-structured interviews were undertaken post monitoring period.

Results: To date 8 participants have been recruited, 4 male and 4 female. Enrolled participants were median of 60.5 (53-71) years of age, receiving median of 100 mg range (24-160) of dexamethasone per cycle of treatment and had received up to 4 lines of previous treatment. We report actigraphy data on 3 participants with completed data. Sleep duration was reduced in 2/3 of participants by 33%, and 43% on dexamethasone nights. There was a reduction in average sleep efficiency (% time asleep when in bed) and a lowering of wake bouts with dexamethasone, 83.0% vs 75.3%, and 29.5 vs 21.0, respectively. The average fragmentation index (a measure of sleep disturbance) slightly increased from 17.2 to 19.8 on dexamethasone nights.

Conclusions: This pilot study has shown the approach to data collection is feasible. It is the first study to objectively characterise sleep disturbances associated with dexamethasone treatment in MM. Our preliminary results indicate a reduction in sleep duration and sleep efficiency on nights participants took dexamethasone. Sleep was more disturbed on these nights, with less, though longer, periods of wakefulness. Data on the full cohort is pending and will be further informed by the qualitative interviews.
Reference
King T, Jagger J, Fethney J, Boustany C, Joshua D, White K (2019). The Steroid Symptom Questionnaire Multiple Myeloma (SSQ-MM): Feasibility, acceptability, reliability and internal consistency. Clinical Lymphoma, Myeloma and Leukemia, 19(10): e341-e341