Palesh Oxana, Zeitzer Jamie M, Conrad Ansgar, Giese-Davis Janine, Mustian Karen M, Popek Varinia, Nga Karen, Spiegel David
University of Rochester Wilmot Cancer Center, Rochester, NY, USA.
J Clin Sleep Med. 2008 Oct 15;4(5):441-9.
To determine the relationship between hypothalamic pituitary axis (HPA) dysregulation, vagal functioning, and sleep problems in women with metastatic breast cancer.
Sleep was assessed by means of questionnaires and wrist actigraphy for 3 consecutive nights. The ambulatory, diurnal variation in salivary cortisol levels was measured at 5 time points over 2 days. Vagal regulation was assessed via respiratory sinus arrhythmia (RSA(TF)) during the Trier Social Stress Task.
Ninety-nine women (54.6 +/- 9.62 years) with metastatic breast cancer.
Longer nocturnal wake episodes (r = 0.21, p = 0.04, N=91) were associated with a flatter diurnal cortisol slope. Sleep disruption was also associated with diminished RSA(TF). Higher RSA baseline scores were significantly correlated with higher sleep efficiency (r = 0.39, p = 0.001, N=68) and correspondingly lower levels of interrupted sleep (waking after sleep onset, WASO; r = -0.38, p = 0.002, N=68), lower average length of nocturnal wake episodes (r = -0.43, p < 0.001, N=68), and a lower self-reported number of hours of sleep during a typical night (r = -0.27, p = 0.02, N=72). Higher RSA AUC was significantly related to higher sleep efficiency (r = 0.45, p < 0.001, N=64), and a correspondingly lower number of wake episodes (r = -0.27, p = 0.04, N=64), lower WASO (r = -0.40, p = 0.001, N=64), and with lower average length of nocturnal wake episodes (r = -0.41, p = 0.001, N=64). While demographics, disease severity, and psychological variables all explained some portion of the development of sleep disruption, 4 of the 6 sleep parameters examined (sleep efficiency, WASO, mean number of waking episodes, average length of waking episode) were best explained by RSA.
These data provide preliminary evidence for an association between disrupted nocturnal sleep and reduced RSA the subsequent day, confirming an association between disrupted nocturnal sleep and flattened diurnal cortisol rhythm in women with metastatic breast cancer. They suggest that the stress-buffering effects of sleep may be associated with improved parasympathetic tone and normalized cortisol patterns during the day.
确定转移性乳腺癌女性下丘脑 - 垂体轴（HPA）功能失调、迷走神经功能与睡眠问题之间的关系。
通过问卷调查和连续三晚的手腕活动记录仪评估睡眠情况。在两天内的5个时间点测量唾液皮质醇水平的动态日间变化。在特里尔社会应激任务期间通过呼吸性窦性心律不齐（RSA(TF)）评估迷走神经调节功能。
99名转移性乳腺癌女性（年龄54.6±9.62岁）。
较长的夜间觉醒时间（r = 0.21，p = 0.04，N = 91）与较平缓的日间皮质醇斜率相关。睡眠中断也与RSA(TF)降低有关。较高的RSA基线分数与较高的睡眠效率显著相关（r = 0.39，p = 0.001，N = 68），相应地，睡眠中断水平较低（睡眠开始后觉醒，WASO；r = -0.38，p = 0.002，N = 68），夜间觉醒时间的平均长度较短（r = -0.43，p < 0.001，N = 68），以及典型夜晚自我报告的睡眠时间较短（r = -0.27，p = 0.02，N = 72）。较高的RSA曲线下面积（AUC）与较高的睡眠效率显著相关（r = 0.45，p < 0.001，N = 64），相应地，觉醒次数较少（r = -0.27，p = 0.04，N = 64），WASO较低（r = -0.40，p = 0.001，N = 64），夜间觉醒时间的平均长度较短（r = -0.41，p = 0.001，N = 64）。虽然人口统计学、疾病严重程度和心理变量都解释了睡眠中断发展的一部分，但所检查的6个睡眠参数中的4个（睡眠效率、WASO、觉醒次数平均值、觉醒时间平均长度）最好由RSA来解释。
这些数据为夜间睡眠中断与次日RSA降低之间的关联提供了初步证据，证实了转移性乳腺癌女性夜间睡眠中断与日间皮质醇节律变平之间的关联。它们表明睡眠的应激缓冲作用可能与白天副交感神经张力改善和皮质醇模式正常化有关。
