Introduction
Despite advances in cancer therapy and survival, childhood cancer
survivors experience a lifelong risk for treatment-related late
effects.1 Compared to the general population,
long-term survivors have an increased risk of cardiovascular
disease,2 metabolic syndrome,2 and
obesity.2 Compared to sibling comparisons or
non-cancer controls, long-term survivors have a higher prevalence of
cerebrovascular events,3 gastrointestinal
complications,4 and pulmonary
deficits.5 Adult survivors of childhood cancer
experience a high and variable burden of chronic health
conditions6 increasing their risk of early
mortality.7
While risk of adverse health outcomes in survivors is largely driven by
treatment exposures, chronic health conditions can be exacerbated by
poor health behaviors. Among a large cohort of adult survivors of
childhood cancer, the observed association between unhealthy lifestyle
behaviors (e.g. diet, physical activity) and metabolic syndrome was
stronger than the association between cranial radiation and metabolic
syndrome.8 Adherence to a Mediterranean diet has been
associated with lower body mass index and lower risk of metabolic
syndrome among leukemia survivors.9 Moreover, physical
activity has been associated with decreased mortality risk among
childhood cancer survivors.10 Identifying and
promoting modifiable lifestyle behaviors may be essential to improving
the health outcomes and quality of life of long-term survivors.
Associations between sleep and health have not been fully elucidated in
survivors; however, in the general population sleep duration is widely
associated with several chronic health conditions. In cross-sectional
examinations of national samples, short and long sleep durations have
been associated with metabolic syndrome,11cardiovascular disease,12 and chronic kidney
disease.13 Moreover, prospective associations between
sleep disturbances and diabetes,14depression,15 gastrointestinal
disease16, and progression to end-stage renal
disease17 have also been reported. The high prevalence
of self-reported sleep disturbances among survivors of childhood cancer
has been well characterized;18,19 however, few studies
have examined health status and poor sleep among childhood cancer
survivors. The purpose of this study was to examine associations between
short sleep duration and clinically-assessed health conditions among
adult survivors of childhood cancer.