Multicenter, Randomized Controlled Trial of Yoga for Sleep Quality Among Cancer Survivors

Oxana G. Palesh, Stanford University, Stanford, CA
Journal of Clinical Oncology (Impact Factor: 18.43). 08/2013; 31(26). DOI: 10.1200/JCO.2012.43.7707
Source: PubMed


PURPOSEThirty percent to 90% of cancer survivors report impaired sleep quality post-treatment, which can be severe enough to increase morbidity and mortality. Lifestyle interventions, such as exercise, are recommended in conjunction with drugs and cognitive behavioral therapy for the treatment of impaired sleep. Preliminary evidence indicates that yoga-a mind-body practice and form of exercise-may improve sleep among cancer survivors. The primary aim of this randomized, controlled clinical trial was to determine the efficacy of a standardized yoga intervention compared with standard care for improving global sleep quality (primary outcome) among post-treatment cancer survivors. PATIENTS AND METHODS
In all, 410 survivors suffering from moderate or greater sleep disruption between 2 and 24 months after surgery, chemotherapy, and/or radiation therapy were randomly assigned to standard care or standard care plus the 4-week yoga intervention. The yoga intervention used the Yoga for Cancer Survivors (YOCAS) program consisting of pranayama (breathing exercises), 16 Gentle Hatha and Restorative yoga asanas (postures), and meditation. Participants attended two 75-minute sessions per week. Sleep quality was assessed by using the Pittsburgh Sleep Quality Index and actigraphy pre- and postintervention.ResultsIn all, 410 survivors were accrued (96% female; mean age, 54 years; 75% had breast cancer). Yoga participants demonstrated greater improvements in global sleep quality and, secondarily, subjective sleep quality, daytime dysfunction, wake after sleep onset, sleep efficiency, and medication use at postintervention (all P ≤ .05) compared with standard care participants. CONCLUSION
Yoga, specifically the YOCAS program, is a useful treatment for improving sleep quality and reducing sleep medication use among cancer survivors.

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Available from: Lisa K Sprod, Nov 15, 2014
    • "The following analyses focused on 16 studies, comprising 575 participants (Beddoe et al., 2010; Bei et al., 2013; Bootzin & Stevens, 2005; Britton et al., 2010; Britton et al., 2012; Cincotta et al., 2011; Garland, 2012; Gross et al., 2011; Innes et al., 2012; Khalsa et al., 2004; Manjunath & Telles, 2005; Mustian et al., 2013; Nakamura et al., 2013; Ong et al., 2008; 2009, Taibi & Vitiello, 2011; see Table 1). "
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    ABSTRACT: Background: Sleep disturbance, including insomnia, is a major health issue among both adults and adolescents. Mindfulness-based interventions (MBIs) have recently received increased attention as a non-pharmacological treatment option for patients with insomnia. Objectives: This meta-analysis assesses the effects of MBIs on sleep disturbance in the general population. Methods: A literature search was conducted using PubMed, Medline, PsychInfo, Google Scholar, and Cochrane library. The search terms were “mindfulness therapy”, “mindfulness based cognitive therapy”, “mindfulness based stress reduction”, “acceptance and commitment therapy”, and “yoga” crossed by “insomnia”, “adults”, “adolescents”, or “children”. All studies in English-language were examined through October 2013. Sixteen studies from different age groups were included in this meta-analysis. Sleep measurements were evaluated before and after MBIs, using both subjective as well as objective methods. Long-term effects were also examined. Results: The meta-analysis included 575 individuals across 16 studies. Ages ranged from 8-87 years and 82.09% of participants were female (472/575). MBIs were associated with increased sleep efficiency (SE; ES = 0.88; p < 0.0001) and total sleep time (TST; ES = 0.47; p = 0.003) as assessed by sleep log. Additionally, wake after sleep onset and sleep onset latency decreased (WASO; ES = -0.84; p < 0.0001; SOL; ES = -0.55; p < 0.00001). Changes in sleep when measured by polysomnography and actigraphy, however, were not statistically significant. Sleep improvements as assessed by sleep log continued 2-6 months following treatment initiation. Interpretation is limited by the small number of studies on MBIs for insomnia, especially in adolescent populations. Conclusion: This meta-analysis suggests efficacy of mindfulness-based interventions for improving sleep, as assessed by subjective sleep logs but not by objective measures, and this continued several months after treatment initiation. More research is needed to explore this promising treatment option for adults and adolescents with insomnia.
    No preview · Article · May 2015 · Adolescent psychiatry
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    • "For centuries, yoga has been recognized as a form of exercise that can yield increased flexibility, lipid profile management, strength and endurance for regular practitioners (Olivo 2009; Ulger and Yagli 2011; Pullen et al. 2008; Gordon et al. 2008; Agte et al. 2011; Phoosuwan et al. 2009). Yoga-based exercise is also emerging as an important practice to be used for cancer survivors, and has been shown to improve survivors' self-reported quality of life (QOL) (Culos-Reed et al. 2006; DiStasio 2008; Banasik et al. 2011; Danhauer et al. 2009; Bower et al. 2012; Buffart et al. 2012; Lengacher et al. 2012; Ulger and Yagli 2010; Van Puymbroeck et al. 2013; Moadel et al. 2007; Mustian et al. 2013; Kiecolt-Glaser et al. 2014). "
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    ABSTRACT: Yoga-based exercise has proven to be beneficial for practitioners, including cancer survivors. This study reports on the effect on inflammatory biological markers for 20 breast cancer survivors who participated in a six-month yoga-based (YE) exercise program. Results are compared to a comprehensive exercise (CE) program group and a comparison (C) exercise group who chose their own exercises. “Pre” and “post” assessments included measures of anthropometrics, cardiorespiratory capacity, and inflammatory markers interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNFα) and C-reactive protein (CRP). Descriptive statistics, effect size (d), and dependent sample ‘t’ tests for all outcome measures were calculated for the YE group. Significant improvements were seen in decreased % body fat, (−3.00%, d = −0.44, p = <.001) but not in cardiorespiratory capacity or in inflammatory serum markers. To compare YE outcomes with the other two groups, a one-way analysis of co-variance (ANCOVA) was used, controlling for age, BMI, cardiorespiratory capacity and serum marker baseline values. We found no differences between groups. Moreover, we did not see significant changes in any inflammatory marker for any group. Our results support the effectiveness of yoga-based exercise modified for breast cancer survivors for improving body composition. Larger studies are needed to determine if there are significant changes in inflammatory serum markers as a result of specific exercise modalities.
    Full-text · Article · Mar 2015 · SpringerPlus
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    • "A major concern among BCSs is sleep disturbances. BCSs complain of sleep disturbances before, during, and after the completion of treatment negatively affecting their functional status and quality of life [2, 3]. "
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    ABSTRACT: . Limited research has been conducted on the moderating effect of race/ethnicity on objective sleep disturbances in breast cancer survivors (BCSs). Objective . To explore racial/ethnic differences in objective sleep disturbances among BCSs and their relationship with self-reported symptoms. Intervention/Methods . Sleep disturbance and symptoms were measured using actigraphy for 72 hours and self-reported questionnaires, respectively, among 79 BCSs. Analysis of covariance, Pearson’s correlation, and multivariate regression were used to analyze data. Results . Sixty (75.9%) participants listed their ethnicity as white, non-Hispanic and 19 (24.1%) as minority. Total sleep time was 395.9 minutes for white BCSs compared to 330.4 minutes for minority BCSs. Significant correlations were seen between sleep onset latency (SOL) and depression, SOL and fatigue, and sleep efficiency (SE) and fatigue among minority BCSs. Among white BCSs, significant correlations were seen between SE and pain and wake after sleep onset (WASO) and pain. The association between depression and SOL and fatigue and SOL appeared to be stronger in minority BCSs than white BCSs. Conclusions . Results indicate that white BCSs slept longer than minority BCSs, and race/ethnicity modified the effect of depression and fatigue on SOL, respectively. Implications for Practice . As part of survivorship care, race/ethnicity should be included as an essential component of comprehensive symptom assessments.
    Full-text · Article · Jul 2014
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