Actigraphy-Measured Sleep Disruption as a Predictor of Survival among Women with Advanced Breast Cancer

被引:167
作者
Palesh, Oxana [1 ]
Aldridge-Gerry, Arianna [1 ]
Zeitzer, Jamie M. [1 ]
Koopman, Cheryl [1 ]
Neri, Eric [1 ]
Giese-Davis, Janine [1 ,2 ]
Jo, Booil [1 ]
Kraemer, Helena [1 ]
Nouriani, Bita [1 ]
Spiegel, David [1 ]
机构
[1] Stanford Univ, Sch Med, Dept Psychiat & Behav Sci, Stanford, CA 94305 USA
[2] Tom Baker Canc Clin, Calgary, AB, Canada
关键词
advanced breast cancer; sleep disruption; sleep efficacy; survival; wake after sleep onset; CLINICAL ONCOLOGY PROGRAM; MORTALITY; DURATION; METAANALYSIS; DISTURBANCE; QUALITY; THERAPY; STRESS; TRIAL;
D O I
10.5665/sleep.3642
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
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收藏
页码:837 / 842
页数:6
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