The majority of patients with cancer who are being treated with World Health Organization (WHO) step III opioids were found to experience poor sleep quality, often because of pain, according to a study published in the British Medical Journal Supportive & Palliative Care.

The study included 604 participants (median age, 62; mean oral daily morphine equivalent dose, 303±542.8 mg/24 hours) with cancer taking WHO step III opioids. The researchers used the Pittsburgh Sleep Quality Index (PSQI) global score (range 0-21; score >5 indicating poor sleep) to assess sleep quality and the Brief Pain Inventory and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 to assess pain and quality of life, respectively.

The mean PSQI global sore was 8.8±4.2, with 78% of participants scoring >5, indicating poor sleep. All PSQI components were affected, with 44% of participants reporting trouble sleeping because of pain.

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Using a multiple regression model, the researchers found that pain intensity, emotional function, constipation, financial difficulties, and Karnofsky performance score were found to be predictors of PSQI global scores (adjusted R2=0.211).

These results indicate that healthcare providers should assess and treat sleep disturbances in patients with advanced cancer.

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“In this study, sleep quality measured by PSQI is related to other medical problems that could be assessed and treated per se and maybe have beneficial effect on sleep: pain intensity, emotional function, fatigue and constipation,” the researchers wrote.


Jakobsen G, Engstrom M, Fayers P, et al. Sleep quality with WHO Step III opioid use for cancer pain [published online July 17, 2018]. BMJ Support Palliat Care. doi:10.1136/ bmjspcare-2017-001399

This article originally appeared on Clinical Pain Advisor