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

Abstract

Context Sleep disturbance is a significant problem in oncology patients. Objectives To examine how actigraphy and self-report ratings of sleep disturbance changed over the course of and following 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 to compare predictors of subjective and objective sleep disturbance. Methods Patients (n=73) completed self-report questionnaires that assessed sleep disturbance, fatigue, depressive symptoms, anxiety, and pain prior to 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 (HLM) was used for data analyses. Results Mean wake after sleep onset (WASO) was 11.9% and mean total score on the General Sleep Disturbance Scale (GSDS) 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. Conclusion Different variables predicted sleep disturbance using subjective and objective measures. The slightly elevated WASO 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.

Kualitas Tidur Pasien Kanker Payudara Berdasarkan Terapi yang Diberikan di RSUP DR. Hasan Sadikin Bandung

“…(2) rasa terbakat akibat radioterapi yang terjadi pada 85% dari 73 pasien yang diteliti menyebabkan mereka harus terbangun sebanyak 15 kali (Dhruva et al, 2012). (3) 67% dari 252 mengalami kualitas tidur buruk akibat kelelahan, nyeri dan stres psikologis (Romito et al, 2014).…”

“…Menurut Dhruva et al (2012), lebih dari 87% dari 73 pasien kanker payudara yang menjalani radioterapi, sering terbangun di malam hari yang terjadi selama tiga atau lebih malam perminggu. Hasil penelitian lain juga mendukung bahwa terapi radiasi menghasilkan penurunan efisiensi tidur, dan lebih banyak waktu yang dihabiskan untuk bangun sehingga mengakibatkan disfungsi siang hari yang lebih tinggi (Miaskowsi dan Lee (1999) dalam Graci, 2005).…”

Variação longitudinal da qualidade do sono em mulheres com câncer de mama

“…(9) Sleep specialists have pointed out the relevance of a subjective assessment -with the use PSQI, as has been the case with the present study -and the significance of interindividual differences, by stating that individuals who perceive to get very little or too much sleep should be instructed to seek a health care professional. (19) Furthermore, data analyzed in a longitudinal study after 2 years of treatment showed that five preoperative symptoms had a long-term predictive effect over the quality of life of women with breast cancer.…”

“…(9) It is also believed that detailed data from methods such as actigraphy and sleep diaries may contribute for gathering relevant information about intraindividual variability over time, which can then be examined for factors negatively or positively affecting sleep quality.…”

“…(7,8) Depressive symptoms are predictors of subjective sleep quality in women with breast cancer before, during and after radiation therapy. (9) Other authors have found that women with early-stage breast cancer when compared with a control group including women without breast cancer, showed a worsening in sleep quality, higher depressive symptoms, more fatigue, and lesser quality of life, one year after chemotherapy. (10) Along the same lines, a different study verified that sleep quality in women with breast cancer may predict quality of life and psychological well-being between 1 and 10 years after treatment.…”