Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida.
School of Aging Studies, University of South Florida, Tampa, Florida.
Cancer. 2018 Feb 1;124(3):499-506. doi: 10.1002/cncr.31024. Epub 2017 Oct 26.
Patients with prostate cancer receiving androgen deprivation therapy (ADT) are at risk of sleep disturbance; however, to the authors' knowledge, the mechanisms by which ADT may affect sleep are not well understood. The current study compared objective and subjective sleep disturbance in ADT recipients and controls and examined whether sleep disturbance in ADT recipients is attributable to the influence of ADT on hot flashes and nocturia.
Patients with prostate cancer were assessed before or within 1 month after the initiation of ADT as well as 6 months and 12 months later (78 patients). Patients with prostate cancer were treated with prostatectomy only (99 patients) and men with no history of cancer (108 men) were assessed at similar intervals. Participants self-reported their sleep disturbance (Insomnia Severity Index) and interference from hot flashes (Hot Flash Related Daily Interference Scale). One hundred participants also wore actigraphs for 3 days at the 6-month assessment to measure objective sleep disturbance and reported their nocturia frequency.
ADT recipients reported worse sleep disturbance, higher rates of clinically significant sleep disturbance, and greater hot flash interference than controls (Ps≤.03). In cross-sectional analyses among those with actigraphy data, ADT recipients had greater objective sleep disturbance and more episodes of nocturia (Ps<.01). Cross-sectional mediation analyses demonstrated that the association between ADT and objectively and subjectively measured sleep disturbance was partly attributable to nocturia and hot flashes (Ps<.05).
The results of the current study suggest that the association between ADT and sleep may be partly explained by nocturia and hot flash interference. Future studies should examine behavioral and pharmacologic interventions to address these symptoms among ADT recipients. Cancer 2018;124:499-506. © 2017 American Cancer Society.
接受雄激素剥夺疗法（ADT）的前列腺癌患者存在睡眠障碍风险；然而，据作者所知，ADT 影响睡眠的机制尚不清楚。本研究比较了 ADT 接受者和对照组的客观和主观睡眠障碍，并探讨了 ADT 接受者的睡眠障碍是否归因于 ADT 对热潮红和夜尿症的影响。
在开始 ADT 之前或之后 1 个月内评估前列腺癌患者，之后分别在 6 个月和 12 个月时进行评估（78 例患者）。仅接受前列腺切除术的前列腺癌患者（99 例）和无癌症史的男性（108 名男性）在相似的时间间隔内进行评估。参与者自我报告他们的睡眠障碍（失眠严重程度指数）和热潮红干扰（热潮红相关日常干扰量表）。100 名参与者还在 6 个月评估时佩戴活动记录仪 3 天，以测量客观睡眠障碍，并报告他们的夜尿症频率。
ADT 接受者报告的睡眠障碍更严重，睡眠障碍发生率更高，热潮红干扰更大，比对照组更严重（P≤.03）。在有活动记录仪数据的横断面分析中，ADT 接受者的客观睡眠障碍更大，夜尿症发作次数更多（P<.01）。横断面中介分析表明，ADT 与客观和主观测量的睡眠障碍之间的关联部分归因于夜尿症和热潮红（P<.05）。
本研究结果表明，ADT 与睡眠之间的关联部分可归因于夜尿症和热潮红干扰。未来的研究应该检查行为和药物干预措施，以解决 ADT 接受者的这些症状。癌症 2018；124:499-506。©2017 美国癌症协会。
