被诊断患有乳腺癌的女性睡眠、小憩、疲劳与皮质醇昼夜节律之间关联的日常动态变化。
Day-to-day dynamics of associations between sleep, napping, fatigue, and the cortisol diurnal rhythm in women diagnosed as having breast cancer.
作者信息
Tell Dina, Mathews Herbert L, Janusek Linda Witek
机构信息
From the Department of Health Promotion (D.T., L.W.J.), Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois; and Department of Microbiology Immunology (H.L.M.), Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois.
出版信息
Psychosom Med. 2014 Sep;76(7):519-28. doi: 10.1097/PSY.0000000000000097.
OBJECTIVES
To examine whether day-to-day variations in sleep behaviors, ongoing sleep disturbance, and fatigue predict the cortisol diurnal rhythm in women recently diagnosed as having early-stage breast cancer.
METHODS
Women (N = 130, mean [standard deviation] age = 55.6 [9.4] years) collected saliva 5×/day/2 days for cortisol. Diaries were used to assess prior-day nap duration, nocturnal awakenings, sleep latency, and morning restfulness. Ongoing fatigue and sleep disturbance were measured using the Multidimensional Fatigue Symptom Inventory and the Pittsburg Sleep Quality Inventory. Data were analyzed using a multilevel growth curve modeling.
RESULTS
Greater ongoing fatigue (b = 0.035, p = .032), or sleep disturbance (b = 0.026, p = .006) predicted a slower cortisol decline. Greater ongoing fatigue also predicted higher awakening cortisol (b = 0.154, p = .030) and lower cortisol awakening response (CAR; b = -0.146, p = .005). Longer prior-day naps predicted higher CAR (b = 0.042, p = .050) and a steeper cortisol decline (b = -0.035, p = .003). Longer sleep latency predicted both a greater cortisol linear decline (b = -0.013, p < .001) and a greater quadratic slope curvature (b = 0.0007, p < .001). Feeling less rested in the morning predicted lower awakening cortisol (b = -0.187, p = .004), higher CAR (b = 0.124, p = .016), and a slower cortisol decline (b = 0.023, p = .042).
CONCLUSIONS
Both daily variations in sleep behaviors and ongoing sleep disturbance and fatigue are associated with a disrupted cortisol rhythm. In contrast, prior-day napping is associated with a more robust cortisol rhythm. These findings are particularly relevant to women with breast cancer who often experience sleep disturbance and fatigue. Additional research is needed to determine causal pathways between sleep disturbance and dysregulation of the hypothalamic-pituitary-adrenal axis in patients with breast cancer.
目的
探讨睡眠行为的日常变化、持续存在的睡眠障碍和疲劳是否能预测近期被诊断为早期乳腺癌的女性的皮质醇昼夜节律。
方法
130名女性（平均[标准差]年龄 = 55.6[9.4]岁）每天分5次采集唾液，共采集2天用于检测皮质醇。通过日记评估前一天的午睡时长、夜间觉醒次数、入睡潜伏期和早晨的精神状态。使用多维疲劳症状量表和匹兹堡睡眠质量指数测量持续的疲劳和睡眠障碍。采用多水平生长曲线模型分析数据。
结果
持续疲劳程度越高（b = 0.035，p = 0.032）或睡眠障碍越严重（b = 0.026，p = 0.006），预测皮质醇下降越缓慢。持续疲劳程度越高还预测觉醒时皮质醇水平越高（b = 0.154，p = 0.030），皮质醇觉醒反应（CAR）越低（b = -0.146，p = 0.005）。前一天午睡时间越长，预测CAR越高（b = 0.042，p = 0.050），皮质醇下降越陡峭（b = -0.035，p = 0.003）。入睡潜伏期越长，预测皮质醇线性下降幅度越大（b = -0.013，p < 0.001），二次斜率曲率越大（b = 0.0007，p < 0.001）。早晨感觉休息不足预示觉醒时皮质醇水平较低（b = -0.187，p = 0.004），CAR较高（b = 0.124，p = 0.016），皮质醇下降较慢（b = 0.023，p = 0.042）。
结论
睡眠行为的日常变化以及持续存在的睡眠障碍和疲劳均与皮质醇节律紊乱有关。相比之下，前一天午睡与更稳定的皮质醇节律有关。这些发现对于经常经历睡眠障碍和疲劳的乳腺癌女性尤为重要。需要进一步研究以确定乳腺癌患者睡眠障碍与下丘脑 - 垂体 - 肾上腺轴失调之间的因果途径。
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