Insomnia and neurocognitive functioning in adult survivors of childhood cancer
Menée aux Etats-Unis auprès de 911 personnes ayant survécu à un cancer diagnostiqué pendant l'enfance (âge moyen : 34 ans), cette étude analyse l'association entre l'insomnie et les performances cognitives (raisonnement verbal, mémoire, attention, fonction exécutive et vitesse de traitement)
In non-cancer populations, insomnia is known to affect neurocognitive processes. Although the prevalence of insomnia appears to be elevated in survivors of childhood cancer, relatively little is known about its association with neurocognitive performance in this at-risk population.911 survivors (51.9% female; mean[SD] age 34[9.0] years; time since diagnosis 26[9.1] years) completed direct assessments of attention, memory, processing speed, and executive functioning and self-reported symptoms of sleep (Pittsburgh Sleep Quality Index), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue) and daytime sleepiness (Epworth Sleepiness Scale). Sex stratified general linear models were used to examine associations between insomnia and neurocognitive performance, with adjustment for treatment exposures and chronic health conditions. All statistical tests were two-sided.Insomnia was reported by 22.1% of females and 12.3% of males (P < 0.001). After adjustment for neurotoxic treatment exposures, insomnia (vs. healthy sleepers with no daytime fatigue/sleepiness) was associated with worse neurocognitive performance in the domains of verbal reasoning, memory, attention, executive function, and processing speed (verbal reasoning: males β=-0.34, P = 0.04, females β=-0.57, P < 0.001; long-term memory: males β=-0.60, P < 0.001, females β=-0.36, P = 0.02; sustained attention: males β=-0.85, P < 0.001, females β=-0.42, P = 0.006; cognitive flexibility: males β=-0.70, P=0.002, females β=-0.40, P = 0.02). Self-reported sleep disturbance without daytime fatigue/sleepiness or daytime fatigue/sleepiness alone were not consistently associated with poorer neurocognitive performance.Insomnia was highly prevalent and contributed to the neurocognitive burden experienced by adult survivors of childhood cancer. Treatment of insomnia may improve neurocognitive problems in survivors.