Diwakar D. Balachandran

• University of Texas MD Anderson Cancer Center

Purpose Sleep disturbances are common in patients with breast cancer, but comprehensive evaluations with patient-reported outcomes (PRO) and sleep evaluation with polysomnography (PSG) are lacking. This study describes sleep disruption using PROs and PSG to identify underlying sleep disorders. Methods A retrospective review of patients with breast...

Immunotherapy has revolutionized treatments for both early and advanced cancers, and as their role evolves, their impact on sleep and circadian rhythms continues to unfold. The recognition, evaluation, and treatment of sleep and circadian rhythm disturbance leads to improved symptom management, quality of life and treatment outcomes. An intricate c...

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) on nasopharyngeal swab (NPS), remains the most reliable and practical test to diagnose coronavirus disease 2019 (COVID-19). Current literature is sparse regarding the rates of discordance between NPS and bronchoalveolar lavage (BAL) in patients w...

Introduction: Survivors of SARS-CoV-2 pneumonia often develop persistent respiratory symptom and interstitial lung abnormalities (ILAs) after infection. Risk factors for ILA development and duration of ILA persistence after SARS-CoV-2 infection are not well described in immunocompromised hosts, such as cancer patients. Methods: We conducted a pr...

Individuals undergoing hematopoietic stem cell transplantation (HSCT) may experience significant sleep disruption before, during, and after their HSCT. Sleep disruption can contribute to symptom burden, increased fatigue, and reduced quality of life. During HSCT, sleep disruption was increased during the first 100 days, with greatest disturbance se...

Overview The respiratory system is particularly susceptible to complications of cancer and cancer therapy. This vulnerability arises from the stringent architectural requirements for gas exchange, the continuous exposure of the respiratory tract to the external environment, and the severe symptoms that can accompany respiratory compromise. Gas exch...

Objectives: Patients with head and neck cancer (HNC) undergoing concurrent chemoradiotherapy (CCRT) often experience pulmonary symptoms. This study evaluated if a 7-week inspiratory muscle training (IMT) program during CCRT is feasible, adherent, and safe in patients with HNC. This study also evaluated the effect of IMT on diaphragm thickness, mob...

Opinion statement Sleep and circadian rhythm disturbance are among the most commonly experienced symptoms in patients with cancer. These disturbances occur throughout the spectrum of cancer care from diagnosis, treatment, and long into survivorship. The pathogenesis of these symptoms and disturbances is based on common inflammatory pathways related...

Context: Cancer patients often experience cancer-related fatigue (CRF) and sleep disturbances due to cancer and cancer treatment, and symptoms can persist long after treatment. Despite these common occurrences, few studies simultaneously characterize CRF and sleep architecture among cancer patients. Objectives: The objective was to characterize...

PurposePulmonary function testing (PFT) in patients with tracheostomies has been perceived as difficult to perform and clinically unreliable. We studied the feasibility, quality, repeatability and clinical significance of PFT.Methods Patients with tracheostomies that underwent PFT from January 1, 2010 to February 29, 2012 were identified. Clinical...

Patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) treated with immune checkpoint inhibitors (ICIs) are at risk of pneumonitis as well as pneumonia (combined henceforth as ICI-related pulmonary complications). Little is known about the cellular and molecular mechanisms underlying ICI-related pulmonary complications. We ch...

Introduction Since immune checkpoint inhibitor (ICI) blockade has become standard therapy for many cancers, immune-related adverse events (irAEs) have increased. ICI-pneumonitis is infrequent but potentially fatal. In cases not responsive to corticosteroids, additional immunosuppression is recommended. Data for use of infliximab in ≥ grade 3 pneumo...

Purpose: Excessive daytime sleepiness (EDS) is commonly reported in patients with cancer, and it is also a cardinal feature of central disorders of hypersomnolence. Multiple sleep latency testing (MSLT) is used for objective assessment. Methods: A retrospective review of patients with cancer history who underwent formal sleep evaluation and MSLT...

Background Thoracentesis using suction is perceived to have increased risk of complications including pneumothorax and re-expansion pulmonary edema (REPE). Current guidelines recommend limiting drainage to 1.5 L to avoid REPE. Our purpose was to examine the incidence of complications with symptom limited drainage of pleural fluid using suction and...

Background: Patients who have pleural effusions typically undergo thoracentesis with examination of pleural fluid in their initial assessment. However, limited data are available on the diagnostic yield of pleural fluid bacterial cultures and fungal and acid-fast bacilli (AFB) smear and cultures in patients with cancer. Methods: We performed a r...

Background: Bronchoscopy is a safe procedure, but current guidelines recommend transfusion for platelets <20 K/μL. Studies of bronchoscopy in thrombocytopenia are limited. Objectives: Our objective was to evaluate the incidence of bleeding with flexible bronchoscopy in those with thrombocytopenia especially those <20 K/μL. Method: We performed...

Dyspnea or breathlessness is one of the most distressing symptom experienced by patients with advanced disease such as cancer, end-stage chronic obstructive pulmonary disease, and heart failure. It can be either continuous or episodic (more frequent). Management is usually interdisciplinary and individualized to a given patient. A combination of st...

Cancer-related fatigue is a common symptom in cancer patients which commonly occurs in relation to sleep disturbance. We report a case of a 35-year-old breast cancer survivor, in whom polysomnography and multiple sleep latency testing were utilized to objectively quantify the contribution of excessive daytime sleepiness to the patient’s cancer-rela...

Context: Episodic dyspnea is one of the most common, debilitating and difficult-to-treat symptoms. Objective: We conducted a pilot study to examine the effect of prophylactic FBT on exercise-induced dyspnea. Methods: In this parallel, double-blind randomized placebo-controlled trial, opioid-tolerant patients were asked to complete a 6 minute w...

Purpose of Review Obstructive sleep apnea (OSA) has been investigated the most within the spectrum of sleep-related breathing disorders in cancer. The purpose of this review is to describe the biological pathways and review the epidemiological studies regarding OSA and cancer, and to additionally explore the spectrum of sleep-related breathing diso...

Opioids adversely influence respiration in five distinct ways. Opioids reduce the respiratory rate, tidal volume, amplitude, reflex responses to hypercapnia and hypoxia, and arousability related necessary for respiratory adaptive responses. Opioids cause impairment of upper pharyngeal dilator muscles leading to obstructive apnea. Opioids cause comp...

Rationale: Placement of an indwelling pleural catheter is an established modality for symptom relief and pleurodesis in the treatment of malignant pleural effusion. Concerns remain regarding possible infectious complications, risk of hemorrhage, and the rate of pleurodesis with the use of pleural catheters in the treatment of hematologic malignanc...

Overview The respiratory system is particularly susceptible to complications of cancer and cancer therapy. This vulnerability arises from the stringent architectural requirements for gas exchange, the continuous exposure of the respiratory tract to the external environment, and the severe symptoms that can accompany respiratory compromise. Gas exch...

Background . The STOP-BANG questionnaire has been used to identify surgical patients at risk for undiagnosed obstructive sleep apnea (OSA) by classifying patients as low risk (LR) if STOP-BANG score < 3 or high risk (HR) if STOP-BANG score ≥ 3. Few studies have examined whether postoperative complications are increased in HR patients and none have...

A case of a 55 year old woman with iatrogenic vocal cord trauma and sleep related symptoms is reported. In particular this case highlights sleep disordered breathing as a delayed complication after iatrogenic vocal cord trauma. The patient developed acute stridor from a contralateral vocal cord hematoma following vocal fold injection for right voca...

Background: Sleep disturbance is a prominent complaint of cancer patients. Most studies have focused on insomnia and cancer-related fatigue. Obstructive sleep apnea (OSA) has been reported in small studies and case reports. Methods: In a retrospective review of patients who underwent formal sleep evaluation and polysomnography (PSG) from 2006 to...

Malignant pleural effusions (MPE) are a frequent cause of dyspnea in cancer patients. While indwelling pleural catheters (IPC) have been used since 1997, there are no studies of quality-adjusted survival following IPC placement. Prospective observational cohort study of patients with MPE treated with IPCs using a standardized algorithm. Global heal...

Cancer-related fatigue (CRF) continues to be a major concern of patients and providers of cancer care. The symptoms are debilitating and can persist for many years after the cancer diagnosis and therapy. Further research is required to address the mechanisms of illness, including a better understanding of the complex interplay between the sleep sys...

PURPOSE: Prostate cancer patients frequently report fatigue, sleep disturbance and insomnia, but polysomnographic data and underlying sleep disorders are not well described. METHODS: All patients with prostate cancer who underwent polysomnography from 9/2006 to 1/2011 were identified. Clinical history and polysomnographic data were reviewed retrosp...

PURPOSE: Periodic limb movement disorder (PLMD) is a common sleep disorder that has been described in several medical conditions including end stage renal disease, iron deficiency, sickle cell anemia, pregnancy, chronic lung disease, myelopathies and neuropathies. Sleep disturbances are common in cancer patients. The contribution of PLMD to sleep d...

Adequate sleep is an important part of a healthy and productive lifestyle. However, chronic sleep restriction is very common. American adults only sleep an average of 6.85 hours per night. Furthermore, only 37% of Americans report taking more than 8 hours of sleep each night, and 31% of adults report sleeping less than 6 hours per night. Competing...

s: Thirty-Second Annual CTRC‐AACR San Antonio Breast Cancer Symposium‐‐ Dec 10‐13, 2009; San Antonio, TX Background. Complaints of sleep disturbances are common in patients with breast cancer and may affect their quality of life. Insomnia, fatigue, and sleep fragmentation were previously reported in these patients. However, no studies reported pol...

Of the 130 patients studied, 16 patients (2 female, 14 male) were identified with head and neck cancer. All patients underwent a sleep evaluation. Thirteen patients had completed treatment, 2 patients were receiving active chemotherapy, and 1 patient was receiving active chemoradiotherapy. One was referred for history of OSA, 1 had witnessed desatu...

CD43 is a highly glycosylated transmembrane protein that regulates T cell activation. CD43(-/-) T cells are hyperproliferative and the cytoplasmic tail of CD43 has been found to be sufficient to reconstitute wild-type proliferation levels, suggesting an intracellular mechanism. In this study, we report that upon TCR ligation CD43(-/-) T cells demon...

Obstructive sleep apnea (OSA) is characterized by repetative obstruction of the upper airway. Positive airway pressure has evolved as the preferred therapeutic modality for OSA. PAP can be used successfully to treat both OSA and central sleep apnea (CSA). PAP usage affects a variety of medical diseases. Proper titration and attention to compliance...

Persistent airway inflammation, mucus production, and airway hyperreactivity are the major contributors to the frequency and severity of asthma. Why lung inflammation persists in asthmatics remains unclear. It has been proposed that Fas-mediated apoptosis of inflammatory cells is a fundamental mechanism involved in the resolution of eosinophilic ai...

Information related to the clinical characteristics and isolated microbes associated with lung abscesses comparing immunocompromised (IC) to non-immunocompromised (non-IC) patients is limited. A retrospective review for 1984-1996 identified 34 consecutive adult cases of lung abscess (representing 0.2% of all cases of pneumonia), including 10 non-IC...

To assess the potential use of peripheral blood CD4 + T-lymphocyte counts (CD4 + counts) as a clinically useful biological marker to identify specific immunocompromised patients (without HIV infection) at high risk for Pneumocystis carinii pneumonia (PCP). Prospective observational study. Three hundred seventy-five-bed tertiary-care urban referral...