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Sleep and survival among women with breast cancer: 30 years of follow-up within the Nurses' Health Study.

ABSTRACT: Breast cancer is a leading cause of cancer death in women. Sleep has been linked with mortality among cancer-free population; however, its association with survival among women with breast cancer is understudied.Breast cancer patients (N=3682) reported their average sleep duration post diagnosis. Subsamples also provided their pre-diagnosis sleep duration (n=1949) and post-diagnosis sleep difficulties (n=1353). Multivariate Cox models estimated hazard ratios (HR) and confidence intervals (CI) of all-cause, breast cancer, and non-breast cancer mortality.At diagnosis, the mean age was 64.9 years and 91.7% were stage I or II. Women sleeping ?9?h per night post diagnosis had a strong higher risk of all-cause (multivariate HRs: MV-HR=1.37, CI=1.10-1.71), breast cancer (MV-HR=1.46, CI=1.02-2.07), and non-breast cancer mortality (MV-HR=1.34, CI=1.01-1.79), compared to women sleeping 8?h per night. Increased sleep duration post diagnosis (vs unchanged) and regular sleep difficulties (vs rare/none) were associated with a strong elevated risk of all-cause mortality (MV-HRincreased duration=1.35, CI=1.04-1.74; MV-HRregular difficulties=1.49, CI=1.02-2.19) and a moderate greater risk of breast cancer and non-breast cancer mortality.Various facets of sleep were associated with higher all-cause mortality risk. If replicated, these findings support evaluation of breast cancer patients' sleep duration and difficulties to identify those at risk for poorer outcomes.

SUBMITTER: Trudel-Fitzgerald C

PROVIDER: S-EPMC5418457 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Sleep and survival among women with breast cancer: 30 years of follow-up within the Nurses' Health Study.

Trudel-Fitzgerald Claudia C Zhou Eric S ES Poole Elizabeth M EM Zhang Xuehong X Michels Karin B KB Eliassen A Heather AH Chen Wendy Y WY Holmes Michelle D MD Tworoger Shelley S SS Schernhammer Eva S ES

British journal of cancer 20170330 9

<h4>Background</h4>Breast cancer is a leading cause of cancer death in women. Sleep has been linked with mortality among cancer-free population; however, its association with survival among women with breast cancer is understudied.<h4>Methods</h4>Breast cancer patients (N=3682) reported their average sleep duration post diagnosis. Subsamples also provided their pre-diagnosis sleep duration (n=1949) and post-diagnosis sleep difficulties (n=1353). Multivariate Cox models estimated hazard ratios (H ...[more]

PMID: 28359077

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Project description:ObjectiveTo examine the effects of prescription sleep medications on patient-reported sleep disturbances.DesignRetrospective cohort.SettingLongitudinal cohort of community-dwelling women in the USA.ParticipantsRacially and ethnically diverse middle-aged women who reported a sleep disturbance.InterventionsNew users of prescription sleep medications propensity score matched to women not starting sleep medications.Main outcomes and measuresSelf-reported sleep disturbance during the previous 2 weeks-difficulty initiating sleep, waking frequently and early morning awakening-using a 5-point Likert scale, ranging from no difficulty on any night (rating 1) to difficulty on 5 or more nights a week (rating 5). Sleep disturbances were compared at 1 year (primary outcome) and 2 years of follow-up.Results238 women who started sleep medications were matched with 447 non-users. Participants had a mean age of 49.5 years and approximately half were white. At baseline, sleep disturbance ratings were similar: medication users had a mean score for difficulty initiating sleep of 2.7 (95% CI 2.5 to 2.9), waking frequently 3.8 (95% CI 3.6 to 3.9) and early morning awakening 2.8 (95% CI 2.6 to 3.0); non-users ratings were 2.6 (95% CI 2.5 to 2.7), 3.7 (95% CI 3.6 to 3.9) and 2.7 (95% CI 2.6 to 2.8), respectively. After 1 year, ratings for medication users were 2.6 (95% CI 2.4 to 2.8) for initiating sleep, 3.6 (95% CI 3.4 to 3.8) for waking frequently and 2.8 (95% CI 2.6 to 3.0) for early morning awakening; for non-users, the mean ratings were 2.3 (95% CI 2.2 to 2.5), 3.5 (95% CI 3.3 to 3.6) and 2.5 (95% CI 2.3 to 2.6), respectively. None of the 1 year changes were statistically significant nor were they different between medication users and non-users. Two-year follow-up results were consistent, without statistically significant reductions in sleep disturbance in medication users compared with non-users.ConclusionsThese analyses suggest that women who initiated sleep medications rated their sleep disturbances similar after 1 and 2 years. The effectiveness of long-term sleep medication use should be re-examined.

Dataset Information

Sleep and survival among women with breast cancer: 30 years of follow-up within the Nurses' Health Study.

Publications

Sleep and survival among women with breast cancer: 30 years of follow-up within the Nurses' Health Study.

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