BACKGROUND: Poor sleep, prevalent among cancer survivors, is associated with disrupted hormonal circadian rhythms and poor quality of life. Using a prospective research design, this study aimed to clarify the relationship between objective measures of sleep efficiency and sleep disruption with survival among women with advanced breast cancer. METHOD: We examined sleep quality and duration via wrist-worn actigraphy and sleep diaries for 3 days among 97 women in whom advanced breast cancer was diagnosed (age = 54.6 ± 9.8 years). Sleep efficiency was operationalized using actigraphy as the ratio of total sleep time to total sleep time plus wake after sleep onset. RESULTS: As hypothesized, better sleep efficiency was found to predict a significant reduction in overall mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94-0.98; P < 0.001) at median 6 y follow-up. This relationship remained significant (HR, 0.94; 95% CI, 0.91-0.97; P < 0.001) even after adjusting for other known prognostic factors (age, estrogen receptor status, cancer treatment, metastatic spread, cortisol levels, and depression). Secondary hypotheses were also supported (after adjusting for baseline prognostic factors) showing that less wake after sleep onset (HR, 0.41; 95% CI, 0.25-0.67; P < 0.001), fewer wake episodes, (HR, 0.93; 95% CI, 0.88-0.98; P = 0.007); and shorter wake episode duration (HR, 0.29; 95% CI, 0.14-0.58; P < 0.001) also contributed to reductions in overall mortality. CONCLUSIONS: These findings show that better sleep efficiency and less sleep disruption are significant independent prognostic factors in women with advanced breast cancer. Further research is needed to determine whether treating sleep disruption with cognitive behavioral and/or pharmacologic therapy could improve survival in women with advanced breast cancer.
BACKGROUND: Poor sleep, prevalent among cancer survivors, is associated with disrupted hormonal circadian rhythms and poor quality of life. Using a prospective research design, this study aimed to clarify the relationship between objective measures of sleep efficiency and sleep disruption with survival among women with advanced breast cancer. METHOD: We examined sleep quality and duration via wrist-worn actigraphy and sleep diaries for 3 days among 97 women in whom advanced breast cancer was diagnosed (age = 54.6 ± 9.8 years). Sleep efficiency was operationalized using actigraphy as the ratio of total sleep time to total sleep time plus wake after sleep onset. RESULTS: As hypothesized, better sleep efficiency was found to predict a significant reduction in overall mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94-0.98; P < 0.001) at median 6 y follow-up. This relationship remained significant (HR, 0.94; 95% CI, 0.91-0.97; P < 0.001) even after adjusting for other known prognostic factors (age, estrogen receptor status, cancer treatment, metastatic spread, cortisol levels, and depression). Secondary hypotheses were also supported (after adjusting for baseline prognostic factors) showing that less wake after sleep onset (HR, 0.41; 95% CI, 0.25-0.67; P < 0.001), fewer wake episodes, (HR, 0.93; 95% CI, 0.88-0.98; P = 0.007); and shorter wake episode duration (HR, 0.29; 95% CI, 0.14-0.58; P < 0.001) also contributed to reductions in overall mortality. CONCLUSIONS: These findings show that better sleep efficiency and less sleep disruption are significant independent prognostic factors in women with advanced breast cancer. Further research is needed to determine whether treating sleep disruption with cognitive behavioral and/or pharmacologic therapy could improve survival in women with advanced breast cancer.
Entities:
Keywords:
advanced breast cancer; sleep disruption; sleep efficacy; survival; wake after sleep onset
Authors: Kristin Garrett; Anand Dhruva; Theresa Koetters; Claudia West; Steven M Paul; Laura B Dunn; Bradley E Aouizerat; Bruce A Cooper; Marylin Dodd; Kathryn Lee; William Wara; Patrick Swift; Christine Miaskowski Journal: J Pain Symptom Manage Date: 2011-03-31 Impact factor: 3.612
Authors: Oxana G Palesh; Karen M Mustian; Luke J Peppone; Michelle Janelsins; Lisa K Sprod; Shelli Kesler; Pasquale F Innominato; Thomas Roth; Rachel Manber; Charles Heckler; Kevin Fiscella; Gary R Morrow Journal: Sleep Med Date: 2012-08-02 Impact factor: 3.492
Authors: Karen M Mustian; Lisa K Sprod; Michelle Janelsins; Luke J Peppone; Oxana G Palesh; Kavita Chandwani; Pavan S Reddy; Marianne K Melnik; Charles Heckler; Gary R Morrow Journal: J Clin Oncol Date: 2013-08-12 Impact factor: 44.544
Authors: A Nicolini; R Giardino; A Carpi; P Ferrari; L Anselmi; S Colosimo; M Conte; M Fini; G Giavaresi; P Berti; P Miccoli Journal: Biomed Pharmacother Date: 2006-08-28 Impact factor: 6.529
Authors: Jennifer L Steel; Lauren Terhorst; Kevin P Collins; David A Geller; Yoram Vodovotz; Juliana Kim; Andrew Krane; Michael Antoni; James W Marsh; Lora E Burke; Lisa H Butterfield; Frank J Penedo; Daniel J Buysse; Allan Tsung Journal: Psychosom Med Date: 2018-06 Impact factor: 4.312
Authors: Catherine R Marinac; Sandahl H Nelson; Shirley W Flatt; Loki Natarajan; John P Pierce; Ruth E Patterson Journal: Breast Cancer Res Treat Date: 2017-02-11 Impact factor: 4.872
Authors: Eric S Zhou; Ann H Partridge; Karen L Syrjala; Alexis L Michaud; Christopher J Recklitis Journal: J Cancer Surviv Date: 2016-08-05 Impact factor: 4.442
Authors: Amy S DeSantis; Tamara Dubowitz; Bonnie Ghosh-Dastidar; Gerald P Hunter; Matthew Buman; Daniel J Buysse; Lauren Hale; Wendy M Troxel Journal: Sleep Health Date: 2019-06-14
Authors: Amanda I Phipps; Parveen Bhatti; Marian L Neuhouser; Chu Chen; Tracy E Crane; Candyce H Kroenke; Heather Ochs-Balcom; Michelle Rissling; Beverly M Snively; Marcia L Stefanick; Miriam M Treggiari; Nathaniel F Watson Journal: J Clin Sleep Med Date: 2016-04-15 Impact factor: 4.062