12. Sleep Disturbance in the First Year After Mastectomy Among Patients With or Without Reconstruction

Abstract

Purpose: Reconstruction following mastectomy has become increasingly popular. Sleep disturbances following surgery have the potential to adversely impact quality of life. It is important for breast and reconstructive surgeons to understand how surgical extent, including reconstruction, may impact sleep habits of their patients. In this prospective longitudinal study, we aimed to examine sleep disturbance in patients who underwent mastectomy with and without reconstruction throughout the first year following surgery. Methods: Patients completed the PROMIS Sleep Disturbance short form preoperatively and then at 2 weeks, 6 months, and 12 months post-operatively. Independent sample t-test or Mann-Whitney U tests were used to compare groups who did or did not receive reconstruction. Association of factors with sleep disturbance over time was investigated using GEE linear regression. Results: This subset (n=123) of a larger cohort of postoperative patients included women who had a mastectomy with and without reconstruction; 34 (28%) had no reconstruction and 89 (72%) had reconstruction. Patients in the group receiving reconstruction were younger (49 vs 58 years, p=0.001) and had longer surgical duration (257 vs 132 minutes, p<0.001), but were not more likely to receive chemotherapy, radiation, or nodal surgery. Baseline anxiety, depression, or Pain Catastrophizing Score (PCS) was not different between groups. Sleep disturbance was higher in the reconstruction group at some later timepoints (6 and 12 months postoperatively (PROMIS sleep disturbance at 6 months:17.5 vs 22, p=0.003; PROMIS sleep disturbance at 6 months:18.7 vs 22.5, p=0.046). However, an overall model assessing sleep disturbance over the first year after surgery which concurrently took both age and surgical type into account, revealed that (younger) age (beta=-0.142, p=0.027), but not surgical type (beta=-2.704, p=0.113) was associated with greater sleep disturbance. Conclusion: Overall, this study suggests that younger age, rather than surgical types, is associated with greater sleep disturbance in the first year after surgery.