Berger Ann M, Kuhn Brett R, Farr Lynne A, Lynch James C, Agrawal Sangeeta, Chamberlain Julie, Von Essen Susanna G
University of Nebraska Medical Center, Omaha, NE 68198-5330, USA.
Psychooncology. 2009 Jun;18(6):634-46. doi: 10.1002/pon.1438.
To determine whether sleep quality and fatigue associated with breast cancer adjuvant chemotherapy treatments can be improved with behavioral therapy (BT) [Individualized Sleep Promotion Plan (ISPP)] including modified stimulus control, modified sleep restriction, relaxation therapy, and sleep hygiene.
Randomized-controlled trial based on Piper Integrated Fatigue Model, 219 stages I-IIIA breast cancer patients. Prior to the initial chemotherapy treatment, BT participants developed an ISPP plan that was regularly reinforced and revised. Controls received healthy eating information and attention. Pittsburgh Sleep Quality Index (PSQI), daily diary, actigraph, and Piper Fatigue Scale (PFS) data were collected 2 days prior, during the 7 days after each treatment, and 30 days after the last treatment. Repeated measures analysis of variance was used.
Prior to chemotherapy, participants reported mild fatigue and fairly poor sleep quality. All variables changed over time. A group by time interaction was found for sleep quality (PSQI) improving in the BT group. Diary revealed group differences on number of awakenings, minutes awake after sleep onset, and sleep efficiency. Fatigue (PFS) was similar between groups.
The BT group showed improved sleep quality over time and better sleep (diary). Perceptions of improved sleep quality over time are not consistently associated with diary or actigraph, or result in lower fatigue.
确定行为疗法（BT）[个体化睡眠促进计划（ISPP）]，包括改良的刺激控制、改良的睡眠限制、放松疗法和睡眠卫生，是否可以改善与乳腺癌辅助化疗治疗相关的睡眠质量和疲劳。
基于派珀综合疲劳模型的随机对照试验，219例I-IIIA期乳腺癌患者。在初始化疗治疗前，BT组参与者制定了一份ISPP计划，该计划会定期强化和修订。对照组接受健康饮食信息和关注。在每次治疗前2天、治疗后的7天以及最后一次治疗后30天收集匹兹堡睡眠质量指数（PSQI）、每日日记、活动记录仪和派珀疲劳量表（PFS）数据。采用重复测量方差分析。
化疗前，参与者报告有轻度疲劳和相当差的睡眠质量。所有变量随时间变化。发现BT组的睡眠质量（PSQI）存在组间时间交互作用改善。日记显示两组在觉醒次数、入睡后清醒分钟数和睡眠效率方面存在差异。两组之间的疲劳（PFS）相似。
随着时间的推移，BT组的睡眠质量有所改善，睡眠状况更好（日记记录）。随着时间的推移，对睡眠质量改善的认知与日记或活动记录仪记录并不一致相关，也不会导致更低的疲劳感。
