Fontes Filipa, Severo Milton, Gonçalves Marta, Pereira Susana, Lunet Nuno
ISPUP - EPIUnit, Universidade do Porto, Rua das Taipas, 4050-600 Porto, Portugal.
ISPUP - EPIUnit, Universidade do Porto, Rua das Taipas, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof Hernâni Monteiro, 4200-319 Porto, Portugal.
Sleep Med. 2017 Jun;34:193-199. doi: 10.1016/j.sleep.2017.03.022. Epub 2017 Apr 4.
To identify trajectories of sleep quality up to three years after breast cancer diagnosis and to assess differences in characteristics of patients across distinct trajectories.
A total of 458 breast cancer patients underwent a neurological evaluation before treatment and at one and three years after diagnosis. Clinical data were obtained throughout the follow-up. Anxiety and depression were evaluated at baseline, using the Hospital Anxiety and Depression Scale. In all sessions of follow-up, sleep quality was assessed using the Pittsburgh Sleep Quality Index. Model-based clustering was used to identify groups of patients with homogeneous variation in sleep quality.
We identified three trajectories of variation in sleep quality, named "low" (LSQ), "medium" (MSQ), and "high sleep quality" (HSQ). Women in the HSQ trajectory presented good sleep quality during the three years. LSQ and MSQ trajectories were characterized by poor sleep quality during the whole period, although during the first year the latter depicted a significant deterioration of sleep quality and the former a significant improvement. Patients included in the LSQ trajectory were more likely to have clinically significant anxiety and depression at baseline. The two trajectories with worse sleep quality were associated with neuropathic pain three years after cancer diagnosis.
This study provides a model for describing the variation in sleep quality during the first three years after breast cancer diagnosis, based on three main trajectories. Further studies are needed understanding the heterogeneity of the individual trajectories within each of these major patterns of variation.
确定乳腺癌诊断后长达三年的睡眠质量轨迹，并评估不同轨迹患者特征的差异。
共有458例乳腺癌患者在治疗前以及诊断后1年和3年接受了神经学评估。在整个随访过程中获取临床数据。使用医院焦虑抑郁量表在基线时评估焦虑和抑郁情况。在所有随访阶段，使用匹兹堡睡眠质量指数评估睡眠质量。基于模型的聚类用于识别睡眠质量具有同质变化的患者组。
我们确定了睡眠质量变化的三条轨迹，分别命名为“低”（LSQ）、“中”（MSQ）和“高睡眠质量”（HSQ）。HSQ轨迹的女性在三年中睡眠质量良好。LSQ和MSQ轨迹的特点是在整个期间睡眠质量较差，尽管在第一年，后者睡眠质量显著恶化，前者显著改善。纳入LSQ轨迹的患者在基线时更有可能有临床上显著的焦虑和抑郁。睡眠质量较差的两条轨迹与癌症诊断三年后的神经性疼痛相关。
本研究提供了一个基于三条主要轨迹描述乳腺癌诊断后前三年睡眠质量变化的模型。需要进一步研究了解这些主要变化模式中每个个体轨迹的异质性。
