July 2008

Document Type


Degree Name



Oregon Health & Science University


Purpose: This dissertation describes nocturnal sleep-wake activity of adolescents receiving chemotherapy and explores relationships between sleep, disease and treatment related symptoms, and quality of life. Sample: 51 adolescents (ages 10 to 19 years) with a primary, secondary, or relapse of cancer (median time since diagnosis of four months) were enrolled. All participants lived and were treated in the Pacific Northwest. Methods: Nocturnal sleep-wake activity was assessed using objective (i.e. actigraphy) and subjective (i.e. 7- Day Sleep Diary, Adolescent Sleep Wake Scale, Adolescent Sleep Hygiene Scale measures). Symptoms and quality of life were assessed using the Memorial Symptom Assessment Scale (MSAS 7-12) and Pediatric Quality of Life Inventory Version 4.0 Teen Report (PedsQL), respectively. Major Findings: Mean sleep start time was 23:11 (SD = 1:05) and sleep end time was 8:52 (SD = 1:10). The mean sleep duration was 581 minutes (SD = 67), mean total sleep time (TST) was 500 minutes (SD = 60), mean wake after sleep onset (WASO) was 80 minutes (SD = 29), and mean sleep efficiency was 82% (SD = 5%). The mean number of symptoms was 4 out of 10. The most prevalent symptoms were tiredness (67%), nausea (51%), pain (48%), and changes in appetite (48%); and the most distressing symptoms were worry (83%), pain (70%), and nausea (62%). The mean PedsQL total score was 60 (SD = 19) with physical health (M = 48, SD = 29) having the lowest subscale score. There were no significant correlations between sleep measures (i.e. TST, WASO) and symptoms or sleep measures and quality of life. There was, however, a significant relationship between symptoms Adolescents Receiving Chemotherapy 10 after treatment and quality of life (r = -.375, p = .019). Limitations: The study was limited by the cross-sectional design (i.e., the broad approaches to age and cancer and the potential for a response-shift). Implications: A primary sleep disturbance in this population may be fragmented sleep rather than the usual truncated sleep period seen in healthy adolescents. Actigraphy was useful in identifying the nature of the sleep disturbance in this population.




School of Nursing



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