{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T05:14:31Z","timestamp":1767849271162,"version":"3.49.0"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T00:00:00Z","timestamp":1675209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Introduction: Non-small-cell lung cancer is still diagnosed at an inoperable stage and systematic treatment is the only option. Immunotherapy is currently considered to be the tip of the arrow as the first-line treatment for patients with a programmed death-ligand 1 \u2265 50. Sleep is known to be an essential part of our everyday life. Patients and Methods: We investigated, upon diagnosis and after nine months, 49 non-small-cell lung cancer patients undergoing immunotherapy treatment with nivolumab and pemprolisumab. A polysomnographic examination was conducted. Moreover, the patients completed the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS) and the Medical Research Council (MRC) dyspnea scale. Results: Tukey mean-difference plots, summary statistics, and the results of paired t-test of five questionnaire responses in accordance with the PD-L1 test across groups were examined. The results indicated that, upon diagnosis, patients had sleep disturbances which were not associated with brain metastases or their PD-L1 expression status. However, the PD-L1 status and disease control were strongly associated, since a PD-L1 \u226580 improved the disease status within the first 4 months. All data from the sleep questionnaires and polysomnography reports indicated that the majority of patients with a partial response and complete response had their initial sleep disturbances improved. There was no connection between nivolumab or pembrolisumab and sleep disturbances. Conclusion: Upon diagnosis, lung cancer patients have sleep disorders such as anxiety, early morning wakening, late sleep onset, prolonged nocturnal waking periods, daytime sleepiness, and unrefreshing sleep. However, these symptoms tend to improve very quickly for patients with a PD-L1 expression \u226580, because disease status improves also very quickly within the first 4 months of treatment.<\/jats:p>","DOI":"10.3390\/diseases11010026","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T02:21:12Z","timestamp":1675304472000},"page":"26","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Non-Small-Cell Lung Cancer Immunotherapy and Sleep Characteristics: The Crossroad for Optimal Survival"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5119-2207","authenticated-orcid":false,"given":"Paul","family":"Zarogoulidis","sequence":"first","affiliation":[{"name":"Pulmonary Department, General Clinic Euromedica Private Hospital, 68100 Thessaloniki, Greece"},{"name":"3rd Surgery Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54646 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios","family":"Petridis","sequence":"additional","affiliation":[{"name":"Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, 64556 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoforos","family":"Kosmidis","sequence":"additional","affiliation":[{"name":"3rd Surgery Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54646 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Sapalidis","sequence":"additional","affiliation":[{"name":"3rd Surgery Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54646 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lila","family":"Nena","sequence":"additional","affiliation":[{"name":"Laboratory of Social Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitris","family":"Matthaios","sequence":"additional","affiliation":[{"name":"Oncology Department, General Hospital of Rhodes, 85100 Rhodes, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasilis","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Oncology Department, University Hospital of Larissa, 77543 Thessali, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleni Isidora","family":"Perdikouri","sequence":"additional","affiliation":[{"name":"Oncology Department, General Hospital of Volos, 34456 Volos, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7215-2191","authenticated-orcid":false,"given":"Konstantinos","family":"Porpodis","sequence":"additional","affiliation":[{"name":"Pulmonary Department, \u201cG. Papanikolaou\u201d General Hospital, Aristotle University of Thessaloniki, 54768 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paschalis","family":"Kakavelas","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, General Clinic Euromedica, Private Hospital, 54667 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paschalis","family":"Steiropoulos","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Torrente, M., Sousa, P.A., Hernandez, R., Blanco, M., Calvo, V., Collazo, A., Guerreiro, G.R., Nunez, B., Pimentao, J., and Sanchez, J.C. (2022). An Artificial Intelligence-Based Tool for Data Analysis and Prognosis in Cancer Patients: Results from the Clarify Study. Cancers, 14.","DOI":"10.3390\/cancers14164041"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.7150\/jca.67113","article-title":"Radial Endobronchial Ultrasound for Lung Cancer Diagnosis: Tips and Tricks","volume":"13","author":"Zarogoulidis","year":"2022","journal-title":"J. Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"634","DOI":"10.7150\/jca.28755","article-title":"Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi","volume":"10","author":"Huang","year":"2019","journal-title":"J. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7","DOI":"10.7150\/jca.13081","article-title":"Radial Endobronchial Ultrasound (EBUS) Guided Suction Catheter-Biopsy in Histological Diagnosis of Peripheral Pulmonary Lesions","volume":"7","author":"Zaric","year":"2016","journal-title":"J. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Zarogoulidis, P., Kosmidis, C.S., Hohenforst-Schmidt, W., Matthaios, D., Sapalidis, K., Petridis, D., Perdikouri, E.I., Courcoutsakis, N., Hatzibougias, D., and Arnaoutoglou, C. (2022). Radial-EBUS: CryoBiopsy Versus Conventional Biopsy: Time-Sample and C-Arm. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19063569"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3514","DOI":"10.7150\/jca.20035","article-title":"Multiple guided technologies based on radial probe endobronchial ultrasound for the diagnosis of solitary peripheral pulmonary lesions: A single-center study","volume":"8","author":"Haidong","year":"2017","journal-title":"J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Imani, V., Ahorsu, D.K., Taghizadeh, N., Parsapour, Z., Nejati, B., Chen, H.P., and Pakpour, A.H. (2022). The Mediating Roles of Anxiety, Depression, Sleepiness, Insomnia, and Sleep Quality in the Association between Problematic Social Media Use and Quality of Life among Patients with Cancer. Healthcare, 10.","DOI":"10.3390\/healthcare10091745"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1200\/JCO.2008.16.2008","article-title":"Losing sleep over cancer","volume":"26","author":"Spiegel","year":"2008","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1097\/MPH.0b013e3181f46a46","article-title":"Fatigue, sleep-wake disturbances, and quality of life in adolescents receiving chemotherapy","volume":"33","author":"Erickson","year":"2011","journal-title":"J. Pediatr. Hematol.\/Oncol."},{"key":"ref_10","first-page":"307","article-title":"Effect of postchemotherapy nausea and vomiting on health-related quality of life. The Quality of Life and Symptom Control Committees of the National Cancer Institute of Canada Clinical Trials Group","volume":"5","author":"Osoba","year":"1997","journal-title":"Support. Care Cancer Off. J. Multinatl. Assoc. Support. Care Cancer"},{"key":"ref_11","first-page":"109","article-title":"Sleep disturbances in hospitalized patients with cancer","volume":"23","author":"Sheely","year":"1996","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1186\/s12955-020-01408-x","article-title":"Association between fatigue, pain, digestive problems, and sleep disturbances and individuals\u2019 health-related quality of life: A nationwide survey in South Korea","volume":"18","author":"Baek","year":"2020","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1891\/0739-6686.19.1.249","article-title":"Sleep and fatigue","volume":"19","author":"Lee","year":"2001","journal-title":"Annu. Rev. Nurs. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1200\/JCO.2001.19.3.895","article-title":"Insomnia in the context of cancer: A review of a neglected problem","volume":"19","author":"Savard","year":"2001","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Pataka, A., Kotoulas, S., Kalamaras, G., Schiza, S., Sapalidis, K., Giannakidis, D., Michalopoulos, N., Koulouris, C., Aidoni, Z., and Amaniti, A. (2020). Gender Differences in Obstructive Sleep Apnea: The Value of Sleep Questionnaires with a Separate Analysis of Cardiovascular Patients. J. Clin. Med., 9.","DOI":"10.3390\/jcm9010130"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/j.1759-7714.2012.00156.x","article-title":"Subjective sleep quality in lung cancer patients before and after chemotherapy","volume":"4","author":"Zarogoulidis","year":"2013","journal-title":"Thorac. Cancer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"100648","DOI":"10.1016\/j.ctarc.2022.100648","article-title":"Treatment patterns for advanced non-small cell lung cancer in the US: A systematic review of observational studies","volume":"33","author":"Lee","year":"2022","journal-title":"Cancer Treat. Res. Commun."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"220108","DOI":"10.1148\/rg.220108","article-title":"Imaging of Immune Checkpoint Inhibitor Immunotherapy for Non-Small Cell Lung Cancer","volume":"42","author":"Shroff","year":"2022","journal-title":"Radiographics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1002385","DOI":"10.3389\/fonc.2022.1002385","article-title":"Real-world eligibility for platinum doublet plus immune checkpoint inhibitors in extensive-stage small-cell lung cancer","volume":"12","author":"Rittberg","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1055\/s-2004-829632","article-title":"Greek version of the Epworth Sleepiness Scale","volume":"8","author":"Tsara","year":"2004","journal-title":"Sleep Breath. Schlaf Atm."},{"key":"ref_21","first-page":"1831","article-title":"Psychometric evaluation and feasibility of the Greek Pittsburgh Sleep Quality Index (GR-PSQI) in patients with cancer receiving chemotherapy","volume":"19","author":"Kotronoulas","year":"2011","journal-title":"Support. Care Cancer Off. J. Multinatl. Assoc. Support. Care Cancer"},{"key":"ref_22","first-page":"725","article-title":"Immune factors or depression? Fatigue correlates in Parkinson\u2019s disease","volume":"45","author":"Katsarou","year":"2007","journal-title":"Rev. Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1093\/occmed\/kqx086","article-title":"The MRC breathlessness scale","volume":"67","author":"Williams","year":"2017","journal-title":"Occup. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"999343","DOI":"10.3389\/fonc.2022.999343","article-title":"Pembrolizumab-combination therapy for previously untreated metastatic nonsquamous NSCLC: Real-world outcomes at US oncology practices","volume":"12","author":"Liu","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1080\/17476348.2022.2119132","article-title":"A health condition index for assessing disease progression","volume":"16","author":"Petridis","year":"2022","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"463","DOI":"10.2217\/bmm-2020-0485","article-title":"PD-L1 and standardized uptake value expression in lung cancer: A possible connection for efficient early lung cancer treatment","volume":"15","author":"Zarogoulidis","year":"2021","journal-title":"Biomark. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"946307","DOI":"10.3389\/fonc.2022.946307","article-title":"Insomnia in patients treated with checkpoint inhibitors for cancer: A meta-analysis","volume":"12","author":"Kiss","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.jpsychores.2006.11.008","article-title":"Sleep quality in advanced cancer patients","volume":"62","author":"Mystakidou","year":"2007","journal-title":"J. Psychosom. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1093\/sleep\/30.6.737","article-title":"The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients","volume":"30","author":"Mystakidou","year":"2007","journal-title":"Sleep"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1188\/06.ONF.761-769","article-title":"Sleep-wake disturbances and quality of life in patients with advanced lung cancer","volume":"33","author":"Vena","year":"2006","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Korenev, G., Yakukhnov, S., Druk, A., Golovina, A., Chasov, V., Mirgayazova, R., Ivanov, R., and Bulatov, E. (2022). USP7 Inhibitors in Cancer Immunotherapy: Current Status and Perspective. Cancers, 14.","DOI":"10.3390\/cancers14225539"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1634\/theoncologist.12-S1-4","article-title":"Cancer-related fatigue: The scale of the problem","volume":"12","author":"Hofman","year":"2007","journal-title":"Oncologist"}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/11\/1\/26\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:21:25Z","timestamp":1760120485000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/11\/1\/26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,1]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["diseases11010026"],"URL":"https:\/\/doi.org\/10.3390\/diseases11010026","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,1]]}}}