Insomnia in breast cancer: a prospective observational study

Fleming, L., Randell, K., Stewart, E., Espie, C. A., Morrison, D. S., Lawless, C. and Paul, J. (2019) Insomnia in breast cancer: a prospective observational study. Sleep, 42(3), zsy245. (doi: 10.1093/sleep/zsy245) (PMID:30521041)

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Study Objectives: Insomnia in cancer patients is prevalent, persistent, and confers risk for physical and psychological disorder. We must better understand how insomnia develops in cancer patients and explore the main contributors to its chronicity so that insomnia management protocols can be integrated more effectively within cancer care. This study monitors the etiology of insomnia in breast cancer patients and identifies risk factors for its persistence. Methods: One hundred seventy-three females with newly diagnosed, non-metastatic breast cancer were tracked from diagnosis for 12 months. Participants completed monthly sleep assessments using the Insomnia Severity Index (ISI) and 3 monthly health-related quality-of-life assessments using the European Organisation for Research and Treatment of Cancer - Breast (EORTC QLQ-C30-BR23) scale. Clinical data on disease status and treatment regimens were also assessed. Results: Prior to diagnosis, 25% of participants reported sleep disturbance, including 8% with insomnia syndrome (IS). Prevalence increased at cancer diagnosis to 46% (18% IS) and remained stable thereafter at around 50% (21% IS). We also explored sleep status transitions. The most common pattern was to remain a good sleeper (34%–49%) or to persist with insomnia (23%–46%). Seventy-seven percent of good sleepers developed insomnia during the 12-month period and 54% went into insomnia remission. Chemotherapy (odds ratio = 0.08, 95% confidence interval [CI] 0.02–0.29, p < .001) and pre-diagnosis ISI scores (odds ratio = 1.13/unit increase in pre-diagnosis sleep score, 95% CI 1.05–1.21, p = .001) were identified as the main risk factors for persistent insomnia. Conclusions: These data advance our understanding of insomnia etiology in cancer patients and help identify those who should be prioritized for insomnia management protocols.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Paul, Mr James and Morrison, Dr David and Lawless, Miss Claire
Authors: Fleming, L., Randell, K., Stewart, E., Espie, C. A., Morrison, D. S., Lawless, C., and Paul, J.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
Journal Name:Sleep
Publisher:Oxford University Press
ISSN (Online):1550-9109
Published Online:26 December 2018
Copyright Holders:Copyright © 2018 Sleep Research Society
First Published:First published in Sleep 42(30):zsy245
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
527431Understanding the development of persistent insomnia in breast cancer patientsLeanne FlemingBreast Cancer Now (BRCANNOW)2010MayPR07RI NEUROSCIENCE & PSYCHOLOGY