A Longitudinal Study of Measures of Objective and Subjective Sleep Disturbance in Patients With Breast Cancer Before, During, and After Radiation Therapy

School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Journal of pain and symptom management (Impact Factor: 2.8). 07/2012; 44(2):215-28. DOI: 10.1016/j.jpainsymman.2011.08.010
Source: PubMed

ABSTRACT Sleep disturbance is a significant problem in oncology patients.
To examine how actigraphy and self-report ratings of sleep disturbance changed over the course of and after radiation therapy (RT); investigate whether specific patient, disease, and symptom characteristics predicted the initial levels and/or the characteristics of the trajectories of sleep disturbance; and compare predictors of subjective and objective sleep disturbance.
Patients (n=73) completed self-report questionnaires that assessed sleep disturbance, fatigue, depressive symptoms, anxiety, and pain before the initiation of RT through four months after the completion of RT. Wrist actigraphy was used as the objective measure of sleep disturbance. Hierarchical linear modeling was used for data analyses.
Mean wake after sleep onset was 11.9% and mean total score on the General Sleep Disturbance Scale was 45. More than 85% of the patients had an abnormally high number of nighttime awakenings. Substantial interindividual variability was found for both objective and subjective measures of sleep disturbance. Body mass index predicted baseline levels of objective sleep disturbance. Comorbidity, evening fatigue, and depressive symptoms predicted baseline levels of subjective sleep disturbance, and depressive symptoms predicted the trajectory of subjective sleep disturbance.
Different variables predicted sleep disturbance using subjective and objective measures. The slightly elevated wake after sleep onset found may be an underestimation of the degree of sleep disturbance when it is evaluated in the context of the high number of nighttime awakenings and patient's perception of poor sleep quality and quantity.

15 Reads
  • Source
    • "Chronic pain and co-morbid insomnia are recognized worldwide as serious health problems that severely impact patients' quality of life and productivity. Sleep disturbances are acknowledged among patients with nociceptive pain [1] [46] [85] [90], neuropathic pain [59] [106] and mixed pain conditions such as cancer [18] [20] [27] [32] or low back pain [2] [9] [68] [95]. In fibromyalgia syndrome (FMS), disturbed sleep is one of the key symptoms [47] [54] [58] [71] [80] [82] [83] [91]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sleep disturbances are highly prevalent in chronic pain patients. Understanding their relationship has become an important research topic since poor sleep and pain are assumed to closely interact. To date, human experimental studies exploring the impact of sleep disruption/deprivation on pain perception have yielded conflicting results. This inconsistency may be due to the large heterogeneity of study populations and study protocols previously used. In addition, none of the previous studies investigated the entire spectrum of nociceptive modalities. To address these shortcomings, a standardized comprehensive quantitative sensory protocol was used in order to compare the somatosensory profile of 14 healthy subjects (6 female, 8 male, 23.5 ± 4.1 yr; mean ± SD) after a night of total sleep deprivation (TSD) and a night of habitual sleep in a cross-over design. One night of TSD significantly increased the level of sleepiness (p<0.001) and resulted in higher scores of the State Anxiety Inventory (p<0.01). In addition to previously reported hyperalgesia to heat (p<0.05) and blunt pressure (p<0.05), study participants developed hyperalgesia to cold (p<0.01) and increased mechanical pain sensitivity to pinprick stimuli (p<0.05) but no changes in temporal summation. Paradoxical heat sensations or dynamic mechanical allodynia were absent. TSD selectively modulated nociception, since detection thresholds of non-nociceptive modalities remained unchanged. Our findings show that a single night of TSD is able to induce generalized hyperalgesia and to increase State Anxiety scores. In the future, TSD may serve as a translational pain model to elucidate the pathomechanisms underlying the hyperalgesic effect of sleep disturbances.
    Pain 05/2013; 154(9). DOI:10.1016/j.pain.2013.04.046 · 5.21 Impact Factor
  • Source
    • "The second study, a longitudinal trial of 26 patients undergoing chemotherapy, reported no significant effect of cancer treatment on sleep architecture and sleep continuity.33 Interestingly, studies have generally found at best a moderate relationship between subjective and objective measurements of sleep.11–13 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sleep problems are highly prevalent in cancer patients undergoing chemotherapy. This article reviews existing evidence on etiology, associated symptoms, and management of sleep problems associated with chemotherapy treatment during cancer. It also discusses limitations and methodological issues of current research. The existing literature suggests that subjectively and objectively measured sleep problems are the highest during the chemotherapy phase of cancer treatments. A possibly involved mechanism reviewed here includes the rise in the circulating proinflammatory cytokines and the associated disruption in circadian rhythm in the develop-ment and maintenance of sleep dysregulation in cancer patients during chemotherapy. Various approaches to the management of sleep problems during chemotherapy are discussed with behavioral intervention showing promise. Exercise, including yoga, also appear to be effective and safe at least for subclinical levels of sleep problems in cancer patients. Numerous chal-lenges are associated with conducting research on sleep in cancer patients during chemotherapy treatments and they are discussed in this review. Dedicated intervention trials, methodologi-cally sound and sufficiently powered, are needed to test current and novel treatments of sleep problems in cancer patients receiving chemotherapy. Optimal management of sleep problems in patients with cancer receiving treatment may improve not only the well-being of patients, but also their prognosis given the emerging experimental and clinical evidence suggesting that sleep disruption might adversely impact treatment and recovery from cancer.
    Nature and Science of Sleep 12/2012; 4:151-162. DOI:10.2147/NSS.S18895
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Lymphedema (LE) is a frequent complication following breast cancer treatment. While progress is being made in the identification of phenotypic risk factors for the development of LE, little information is available on the molecular characterization of LE. The purpose of this study was to determine if variations in pro- and anti-inflammatory cytokine genes were associated with LE following breast cancer treatment. Methods and results: Breast cancer patients completed a number of self-report questionnaires. LE was evaluated using bioimpedance spectroscopy. Genotyping was done using a custom genotyping array. No differences were found between patients with (n=155) and without LE (n=387) for the majority of the demographic and clinical characteristics. Patients with LE had a significantly higher body mass index, more advanced disease, and a higher number of lymph nodes removed. Genetic associations were identified for three genes (i.e., interleukin (IL4) 4 (rs2227284), IL 10 (rs1518111), and nuclear kappa factor beta 2 (NFKB2 (rs1056890)) associated with inflammatory responses. Conclusions: These genetic associations suggest a role for a number of pro- and anti-inflammatory genes in the development of LE following breast cancer treatment.
    PLoS ONE 04/2013; 8(4):e60164. DOI:10.1371/journal.pone.0060164 · 3.23 Impact Factor
Show more