Sleep Disorders: Sleep Disorders 1 |

Sleep Disordered Breathing in Multiple Myeloma FREE TO VIEW

Adam Potter, MD; Saadia Faiz, MD; Juan Lopez-Mattei, MD; Lara Bashoura, MD; Diwakar Balachandran, MD
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UT MD Anderson Cancer Center, Houston, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1275A. doi:10.1016/j.chest.2016.08.1389
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SESSION TITLE: Sleep Disorders 1

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Multiple Myeloma (MM) is a hematologic malignancy which affects multiple organ systems. It also carries a high symptom burden including sleep disturbance, fatigue and pain. Studies evaluating sleep disruption in MM are limited. These patients are potentially at a higher risk for developing sleep disordered breathing (SDB) due to the use of narcotic pain medications and cardiac dysfunction. We hypothesize that there is an increased incidence of SDB in MM patients.

METHODS: Preliminary retrospective data was collected on 38 patients who underwent polysomnography (PSG) at the MD Anderson Cancer Center from 2008 to 2013. Patients were referred for sleep consult and PSG based on clinical suspicion of a sleep disorder. Demographic, oncologic staging, symptoms and PSG data were collected and analyzed.

RESULTS: Our cohort consisted of 38 patients (24 male, 14 female), with a median age of 64 years (44-85), and a median BMI of 34.1 kg/m2 (22.3-59.3). The MM was characterized using the International Staging System (ISS) with Stage I (55%), Stage II (37%), and Stage III (8%). Amyloidosis was seen in 4 patients. Primary reason for referral was clinical suspicion of SDB (97%). Of note, 25 (68%) patients were taking narcotic pain medication, and 11(30%) were taking a sleep aide at the time of PSG. Excessive daytime sleepiness and sleep disturbance were present as measured by an elevated median Epworth Sleepiness Scale score, 11 (5-21) and an elevated median Pittsburgh Sleep Quality Index score, 8 (2-16), respectively. Echocardiogram was available on 30 patients and revealed: valvular dysfunction (70%), diastolic dysfunction (41%), left ventricular hypertrophy (37%), and cardiomyopathy (7%). PSG data revealed a median total sleep time of 406 minutes (210-502.5). The median time spent in N1=12% (1-45), N2=68% (50-91), N3=0% (0-34), and REM=14% (0-31). The median AHI was 13 (1-74), and the median Sa02 nadir was 82.5% (56-93). SDB was diagnosed in 95% of patients with obstructive sleep apnea (83%) being the predominate diagnosis. The distribution of the severity of OSA was mild (37%), moderate (36%) and severe (27%). Central sleep apnea (CSA) was diagnosed in 14% of patients, and sleep-related hypoventilation in 3% of patients. Of the patients diagnosed with SDB, 86% were prescribed positive pressure therapy, and 58% were compliant at the time of follow up.

CONCLUSIONS: In this cohort of MM patients with increased sleep symptoms, there was a high incidence (95%) of sleep disorder breathing, primarily OSA (83%), followed by CSA (14%). Significant use of narcotic pain medication and the cardiac abnormalities seen on echocardiography likely contributed to this outcome, but this remains to be further elucidated.

CLINICAL IMPLICATIONS: Based on this data, a heightened clinical suspicion for SDB in MM patients with sleep symptoms may be justified.

DISCLOSURE: The following authors have nothing to disclose: Adam Potter, Saadia Faiz, Juan Lopez-Mattei, Lara Bashoura, Diwakar Balachandran

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