Trudel-Fitzgerald Claudia, Zhou Eric S, Poole Elizabeth M, Zhang Xuehong, Michels Karin B, Eliassen A Heather, Chen Wendy Y, Holmes Michelle D, Tworoger Shelley S, Schernhammer Eva S
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
Br J Cancer. 2017 Apr 25;116(9):1239-1246. doi: 10.1038/bjc.2017.85. Epub 2017 Mar 30.
Breast cancer is a leading cause of cancer death in women. Sleep has been linked with mortality among cancer-free population; however, its association with survival among women with breast cancer is understudied.
Breast cancer patients (N=3682) reported their average sleep duration post diagnosis. Subsamples also provided their pre-diagnosis sleep duration (n=1949) and post-diagnosis sleep difficulties (n=1353). Multivariate Cox models estimated hazard ratios (HR) and confidence intervals (CI) of all-cause, breast cancer, and non-breast cancer mortality.
At diagnosis, the mean age was 64.9 years and 91.7% were stage I or II. Women sleeping ⩾9 h per night post diagnosis had a strong higher risk of all-cause (multivariate HRs: MV-HR=1.37, CI=1.10-1.71), breast cancer (MV-HR=1.46, CI=1.02-2.07), and non-breast cancer mortality (MV-HR=1.34, CI=1.01-1.79), compared to women sleeping 8 h per night. Increased sleep duration post diagnosis (vs unchanged) and regular sleep difficulties (vs rare/none) were associated with a strong elevated risk of all-cause mortality (MV-HR=1.35, CI=1.04-1.74; MV-HR=1.49, CI=1.02-2.19) and a moderate greater risk of breast cancer and non-breast cancer mortality.
Various facets of sleep were associated with higher all-cause mortality risk. If replicated, these findings support evaluation of breast cancer patients' sleep duration and difficulties to identify those at risk for poorer outcomes.
乳腺癌是女性癌症死亡的主要原因。睡眠与无癌症人群的死亡率有关；然而，其与乳腺癌女性患者生存率的关联研究较少。
乳腺癌患者（N = 3682）报告了诊断后的平均睡眠时间。子样本还提供了诊断前的睡眠时间（n = 1949）和诊断后的睡眠困难情况（n = 1353）。多变量Cox模型估计了全因死亡率、乳腺癌死亡率和非乳腺癌死亡率的风险比（HR）及置信区间（CI）。
诊断时，平均年龄为64.9岁，91.7%为I期或II期。诊断后每晚睡眠≥9小时的女性全因死亡风险（多变量HR：MV-HR = 1.37，CI = 1.10 - 1.71）、乳腺癌死亡风险（MV-HR = 1.46，CI = 1.02 - 2.07）和非乳腺癌死亡风险（MV-HR = 1.34，CI = 1.01 - 1.79）均显著高于每晚睡眠8小时的女性。诊断后睡眠时间增加（与不变相比）和经常出现睡眠困难（与罕见/无相比）与全因死亡风险显著升高（MV-HR = 1.35，CI = 1.04 - 1.74；MV-HR = 1.49，CI = 1.02 - 2.19）以及乳腺癌和非乳腺癌死亡风险适度升高有关。
睡眠的各个方面都与更高的全因死亡风险相关。如果得到重复验证，这些发现支持对乳腺癌患者的睡眠时间和睡眠困难情况进行评估，以识别预后较差的风险人群。
