Abstract
Breast cancer survivors frequently report sleep problems, but little research has studied sleep patterns longitudinally. We examined trends in sleep quality and duration up to 15 years before and 20 years after a diagnosis of breast cancer, over time among postmenopausal women participating in the Women’s Health Initiative (WHI). We included 12,098 participants who developed invasive breast cancer after study enrollment. A linear mixed-effects model was used to determine whether the time trend in sleep quality, as measured by the WHI Insomnia Rating Scale (WHIIRS), a measure of perceived insomnia symptoms from the past 4 weeks, changed following a cancer diagnosis. To examine sleep duration, we fit a logistic regression model with random effects for both short (<6 h) and long (≥9 h) sleep. In addition, we studied the association between depressive symptoms and changes in WHIIRS and sleep duration. There was a significantly slower increase in the trend of WHIIRS after diagnosis (β = 0.06; p = 0.03), but there were non-significant increases in the trend of the probability of short or long sleep after diagnosis. The probability of depressive symptoms significantly decreased, though the decrease was more pronounced after diagnosis (p < 0.01). Trends in WHIIRS worsened at a relatively slower rate following diagnosis and lower depression rates may explain the slower worsening in WHIIRS. Our findings suggest that over a long period of time, breast cancer diagnosis does not adversely affect sleep quality and duration in postmenopausal women compared to sleep pre-diagnosis, yet both sleep quality and duration continue to worsen over time.
Highlights
Breast cancer is the most common cancer diagnosis in women.[1]Breast cancer survivors report sleep problems, including poor sleep quality, poor sleep efficiency, and sleep disturbance,[2] as one of their top five most burdensome long-term health issues.[3]
The objective of this study was to determine whether trends in sleep quality and duration changed after cancer diagnosis among 12,098 women in the Women’s Health Initiative (WHI) diagnosed with invasive breast cancer after enrollment
We investigated the trend in depressive symptoms by number of years since diagnosis and found the trend changed following breast cancer diagnosis (β-interaction = −0.04, 95% CI: −0.06– −0.01, z = −1.05, p-interaction
Summary
Breast cancer survivors report sleep problems, including poor sleep quality, poor sleep efficiency, and sleep disturbance,[2] as one of their top five most burdensome long-term health issues.[3] Compared to women without cancer, breast cancer survivors are twice as likely to experience sleep problems, and prior studies demonstrated that 20–90% report sleep disturbances, depending on the study assessment method.[3,4,5,6] Sleep problems may contribute to poorer quality of life and health status among survivors. Little is known about the longer term health effects of sleep disturbance on breast cancer survivors.[12]
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