Abstract
BackgroundSleep disturbances are associated with numerous mood disorders. Similarly, anxiety and depression are associated with modulation of the psychoneuroimmune (PNI) axis. This study hypothesized that changes in both monitored and self-reported measures of sleep would relate to changes in circulating cytokine levels in an emotionally distressed population of cervical cancer survivors.MethodsBiospecimens, patient-reported outcome (PRO) measures, and actigraphy were collected from cervical cancer survivors enrolled in a biobehavioral clinical trial. Longitudinal changes over a 4-month period were examined. Sleep time measured by actigraphy and PRO were analyzed for correlative changes with emotional distress and serum cytokines (n = 71).ResultsLongitudinal change in the actigraph measure of sleep time was inversely associated with changes in depression and anxiety (test for linear trend, p = 0.02 and p = 0.05 respectively), as well as acute-phase response/pro-inflammatory cytokines (test for linear trend, p = 0.003, interleukin (IL)-2; 0.022, IL-1β; 0.0002, IL-6; and 0.049, tumor necrosis factor α). Conversely, changes in self-reported sleep problems were related to an increase in depression and anxiety (p = 0.001 and p = 0.01 respectively), the T helper 2 (Th2) cytokine IL-5 (p = 0.027), and the counter-regulatory cytokine IL-10 (0.016).ConclusionThis study showed that an increase in sleep time or decrease in sleep problems corresponded with a reduction in self-reported emotional distress and attenuation of pro-inflammatory, Th2, and counter-regulatory cytokines. Our results support sleep measurement as a meaningful biobehavioral variable in cancer survivorship. This study also indicates that sleep investigators should be aware that choice of methodology might influence concordance with different classes of immune parameters.
Highlights
The relationship between sleep and emotional distress is complex [1,2,3,4,5,6,7,8]
A comparison of treatment groups, psychosocial telephone counseling (PTC) and usual care (UC), within these participants yielded no significant difference in any parameters in the longitudinal change between time points 1 and 2 (Supplemental Table 1), or at time points 1 or 2 (Supplemental Tables 2 and 3)
Changes over time in these factors correlated in the expected manner, that is, an increase in scored sleep time or decrease in sleep problems correlated with a decrease in emotional distress and a decrease in pro-inflammatory or T helper 2 (Th2) and counter-regulatory cytokines
Summary
The relationship between sleep and emotional distress is complex [1,2,3,4,5,6,7,8]. Sleep disturbances have been described as being predictive of subsequent development of depression or other psychological diagnoses [2, 3]. Considering the link between sleep, inflammation, and emotional distress, we hypothesized that within the cervical cancer survivor population, longitudinal changes in sleep parameters would be associated with both modulation of circulating cytokine levels and patient-reported outcome (PRO) measures of psychological distress as a surrogate for chronic psychological stress. This study hypothesized that changes in both monitored and self-reported measures of sleep would relate to changes in circulating cytokine levels in an emotionally distressed population of cervical cancer survivors. Changes in self-reported sleep problems were related to an increase in depression and anxiety (p = 0.001 and p = 0.01 respectively), the T helper 2 (Th2) cytokine IL-5 (p = 0.027), and the counter-regulatory cytokine IL-10 (0.016). This study indicates that sleep investigators should be aware that choice of methodology might influence concordance with different classes of immune parameters
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