Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA 94143-0610, USA.
Support Care Cancer. 2012 Oct;20(10):2611-9. doi: 10.1007/s00520-012-1381-3.
The purposes of this study were to identify distinct subgroups of patients based on self-reported sleep disturbance prior to through 6 months after breast cancer surgery and evaluate for differences in demographic, clinical, and symptom characteristics among these latent classes.
Women (n = 398) who underwent unilateral breast cancer surgery were enrolled prior to surgery. Patients completed measures of functional status, sleep disturbance (i.e., General Sleep Disturbance Scale (GSDS); higher scores indicate higher levels of sleep disturbance), fatigue, attentional fatigue, depressive symptoms, and anxiety prior to surgery and monthly for 6 months.
Three distinct classes of sleep disturbance trajectories were identified using growth mixture modeling. The high sustained class (55.0%) had high and the low sustained class (39.7%) had low GSDS scores prior to surgery that persisted for 6 months. The decreasing class (5.3%) had high GSDS score prior to surgery that decreased over time. Women in the high sustained class were significantly younger, had more comorbidity and poorer function, and were more likely to report hot flashes compared to the low sustained class. More women who underwent mastectomy or breast reconstruction were in the decreasing class. Decreasing and high sustained classes reported higher levels of physical fatigue, attentional fatigue, depressive symptoms, and anxiety compared to the low sustained class.
A high percentage of women has significant sleep disturbance prior to surgery that persists during subsequent treatments (i.e., radiation therapy and chemotherapy). Clinicians need to perform routine assessments and initiate appropriate interventions to improve sleep prior to and following surgery.
本研究旨在确定乳腺癌手术前 6 个月患者自我报告睡眠障碍的不同亚组，并评估这些潜在类别之间在人口统计学、临床和症状特征方面的差异。
在手术前招募了 398 名接受单侧乳腺癌手术的女性患者。患者在手术前和手术后每月完成功能状态、睡眠障碍（即一般睡眠障碍量表（GSDS）；得分越高表示睡眠障碍程度越高）、疲劳、注意力疲劳、抑郁症状和焦虑的评估。
使用增长混合物建模确定了三种不同的睡眠障碍轨迹类别。高持续类（55.0%）在手术前具有较高的 GSDS 评分，而低持续类（39.7%）在手术前具有较低的 GSDS 评分，并持续了 6 个月。下降类（5.3%）在手术前具有较高的 GSDS 评分，随着时间的推移逐渐下降。高持续类的女性明显比低持续类年轻，合并症更多，功能更差，并且更有可能报告热潮。更多接受乳房切除术或乳房重建的女性属于下降类。与低持续类相比，下降类和高持续类报告的身体疲劳、注意力疲劳、抑郁症状和焦虑水平更高。
相当一部分女性在手术前存在严重的睡眠障碍，并且在随后的治疗（即放射治疗和化学治疗）中持续存在。临床医生需要在手术前后进行常规评估并启动适当的干预措施以改善睡眠。
